Cohort studies of individuals with a suicide attempt are crucial for identifying risk and protective factors to prevent recurrence. The SURVIVE prospective cohort study aims to investigate the demographic and clinical profiles of individuals presenting with suicidal behaviour.

A total of 1,741 individuals (289 adolescents aged 12–17 and 1,443 adults aged 18 and older) were recruited from emergency departments at eight hospitals across five Spanish regions following a suicide attempt. Baseline data were collected using structured clinical interviews and validated self-report instruments. Sociodemographic and psychiatric variables were analysed.

Most participants were female, and approximately 20% were migrants. Religious affiliation was reported by 35.6% of adolescents and 48.4% of adults. Depression and anxiety were the most prevalent psychiatric diagnoses, while trauma-related and eating disorders were more frequent in adolescents, and substance use disorders in adults. Non-suicidal self-injury was reported by 76.6% of adolescents and 40.1% of adults. The most common method of attempt was self-poisoning in both groups. Psychotropic medication use was widespread, with both groups receiving a similar number of prescriptions.

The SURVIVE study provides a detailed characterization of suicide attempters in Spain, highlighting age-specific clinical patterns and contextual risk factors such as migration and religion. These findings underscore the need for tailored prevention strategies that consider developmental stage, psychiatric comorbidity, and social vulnerability.

Registry-based studies can inform suicide prevention by identifying mental disorders with the highest risk. Previous studies focused on severe disorders and suicide, with limited data on non-lethal self-harm or population impact. We quantified individual- and population-level associations of 32 mental disorders with non-lethal intentional self-harm (NLISH) and suicide.

Registry-based cohort study representative for all residents of Catalonia (Spain) aged ≥10 years (2014–2019; n = 645,571). Cause-specific Cox models estimated individual (hazard ratios [HRs]) and population-level (population attributable fractions [PAFs]) associations with NLISH and suicide, stratified by sex and adjusted for age, socioeconomic status, and nationality.

Individual-level associations with NLISH were strongest for borderline personality disorder (BPD; females HR = 26.9 [95%CI 24.9–29.0]; males HR = 18.9 [95%CI 16.7–21.4]). Associations with suicide were strongest for BPD in females (HR = 40.9 [95%CI 28.5–58.8]) and obsessive-compulsive disorder in males (HR = 17.4 [95%CI 5.3–56.5]). Associations with suicide were stronger among females, and those aged 10–44 across mood, substance use, dissociative, borderline personality, and psychotic disorders. Substantial proportions of outcomes were associated with common disorders: depressive episodes (PAFs 29.8–49.8%), substance use disorders (PAFs 25.1–48.7%), mixed anxiety-depressive disorders (PAFs 19.7–53.2%), and adjustment disorders (PAFs 10.6–44.6%).

Depressive, anxiety, adjustment, and substance use disorders are associated with large shares of self-harm and suicide, whereas BPD confers particularly high individual risk. Our findings support multilevel prevention strategies, especially among young people, including improved risk assessment, collaborative care, and timely access to specialized interventions.

Suicide is a major public health challenge requiring early detection of suicidal ideation (SI). Traditional direct questioning methods suffer from stigma and disclosure bias, failing to identify many at-risk individuals. While machine learning (ML) models show promise, most lack external validation. Indirect screening, using psychosocial data rather than direct SI questions, offers a scalable alternative. This study aimed to externally validate an indirect, ML-based SI screening tool. We tested if a model trained on a Slovenian general population sample retained predictive accuracy when applied to an independent Croatian sample during a period of societal stress (pandemic and earthquakes), assessing performance across age and gender subgroups.

A logistic regression model was trained on a Slovenian sample (N = 2,989) and validated on a Croatian sample (N = 2,364). The model used only indirect predictors, including sociodemographics, life satisfaction, behavioral changes, and Brief COPE subscales. The target outcome was the presence of SI (SIDAS score > 0). Performance was measured by the area under the receiver operating characteristic curve (AUROC).

The model demonstrated strong external validity on the entire Croatian sample, achieving an AUROC of 0.80. Performance remained robust across subgroups: males (AUROC = 0.83), females (AUROC = 0.79), younger adults (AUROC = 0.77), and older adults (AUROC = 0.81). Self-blame, behavioral disengagement, and relationship dissatisfaction were key predictors.

An indirect, ML-based screening tool can reliably identify SI risk in the general population. The model demonstrated strong cross-national transferability and resilience during a societal crisis, proving it is a feasible and valid strategy for population-level prevention.

Understanding how suicide rates vary across age, sex, and geography is essential to designing effective prevention strategies. We examined long-term trends in suicide mortality across European countries over three decades, with a focus on age-specific trajectories.

Using the WHO mortality database, we computed annual sex- and age-specific suicide rates (10–14 to 85+ age groups) from 1990 to 2022, for the most populous European countries, and aggregated rates for the EU-27 and four geographical areas (North, West, South, and Centre-East Europe). We also calculated percentage differences across four time periods (1990–1994, 2000–2004, 2010–2014, and 2020–2022), according to data availability.

Suicide rates increased with age, peaking in older individuals (85+) in most countries (e.g., 82.0/100,000 in France in 2020–2022, 77.1/100,000 in Germany among males, in 2020), except in the UK and Northern Europe, where rates peaked at middle age (∼22/100,000 at 45–49, in 2020). EU-27 suicide rates in 2020 ranged from 5.5/100,000 (age 15–19) to 58.2/100,000 (85+) among males, and from 2.6 (15–19) to 8.6/100,000 (85+) among females. Male suicide rates were 3 to 8 times higher than female rates across all ages. While overall rates declined since 1990 in most countries, youth suicide increased after 2010 in Western (e.g., +12%, girls 15–19), Southern (+24.5%, girls 15–19), and Northern (+44%, girls 15–19 and 20–24) Europe. Rates among young and middle-aged adults recently rose in Spain, the UK, and Northern Europe, while they declined in Eastern Europe after the 1990s.

Despite overall declines, our findings highlight marked heterogeneity in sex- and age-specific trends in suicide mortality across Europe. These patterns call for age-tailored prevention strategies that address evolving psychosocial stressors and structural determinants across the lifespan.

Suicide involves an act of volition on the part of the deceased, making it unlike deaths from physical disorders such as cancer or stroke. The latter occur passively and often despite the efforts of the patient to stay alive. Yet when there is a suicide, clinicians involved may often be blamed and families may often feel guilt. This contrasts with the default response of praise and thanks to clinicians following treatment preceding deaths from physical disorders.

Comparative standardized mortality rate (SMR) data are analyzed to demonstrate the impact of developments in care over the past two decades in the United Kingdom (UK), and similar United States (USA) SMR data are noted. The evidence is reviewed regarding our ability to predict who will die by suicide, when and where to target intervention, and practical and effective prevention methods.

Data from the UK are presented that reflects the relative lack of impact of prevention efforts on suicide mortality rates when compared to the reductions seen in various physical disorders. This narrative review comments on the causes and consequences of this difference.

The challenge for psychiatry is that SMR data suggest that we have been unable to significantly reduce suicide SMR unlike that for physical disorders. This needs to be fully acknowledged and the biased assumption of blame needs to stop. The focus needs to be on evidence-based interventions that do work, such as medications, psychological treatments, psychological interventions, and suicide prevention research.

Among the clinical features of bipolar disorder (BD), sleep disturbances are highly prevalent and persist across all phases of the illness, from onset to acute and inter-episodic periods. Substantial evidence suggests that sleep disturbances may function as proximal triggers for suicidal behavior, independent of other underlying psychiatric conditions. Although suicide is a major clinical concern in BD, the interplay between sleep disturbances and suicidality remains incompletely understood.

We conducted a systematic review and meta-analysis (SRMA) following the PRISMA guidelines. We performed a comprehensive search across PubMed, PsycINFO, and SCOPUS, including all studies reporting an association between sleep disturbances and suicidal behavior in BD. A total of 16 reports, comprising 14 cross-sectional studies and two longitudinal studies, were included in this SRMA.

Among individuals with BD, sleep disturbances were associated with increased odds of lifetime suicidal behaviors (OR = 1.51, 95% CI = 1.23, 1.86), and a history of suicide attempts was associated with significantly elevated odds of experiencing sleep disturbances (OR = 1.37, 95% CI = 1.21, 1.55). In addition, poor sleep quality as measured by the Pittsburgh Sleep Quality Index positively correlated with suicidality (r = 0.24, 95% CI = 0.10, 0.36).

These results highlight the link between sleep disturbances and suicidal tendencies in individuals with BD. Prompt recognition and treatment of sleep disturbances could be crucial for averting or reducing suicidal behaviors in this population.

People with severe mental disorders (SMDs) have about 15 years shorter life expectancy than the general population. Cardiovascular disease (CVD) is among the leading causes of premature mortality and shares genetic underpinnings with SMDs. We investigated the link between clinical traits in SMDs and time to the first CVD diagnosis.

The study included 1,627 well-characterized participants with schizophrenia spectrum (SCZ, N = 998) and bipolar spectrum disorders (BDs, N = 629), and a reference group of 1,201 healthy controls. CVD diagnoses were obtained from two Norwegian national registries (covering both primary and specialist health care) for the period of 2006–2020. Applying Cox proportional hazard models, we investigated associations between SMD clinical traits and time to first CVD diagnosis in SMD participants, adjusting for age, sex, diagnosis, and tobacco use.

Among individuals with SMD, recurring self-harming behavior (SHB) was associated with a shorter time to first CVD diagnosis (p = .029) relative to those without SHB. In the subgroup with SHB and a history of attempted suicide(s), more suicide attempts were associated with shorter time to first CVD diagnosis (p = .041). Significant associations of time to first CVD diagnosis with age at SMD onset and comorbid substance use disorder were not demonstrated.

SHB and a history of suicide attempts in individuals with SMD seem to be associated with earlier CVD onset, and may improve the prediction of CVD, in addition to standard cardiovascular risk factors.

The significant heterogeneity among individuals who die by suicide complicates prevention, suggesting that a “one-size-fits-all” approach is insufficient. It is crucial to identify distinct subgroups for targeted strategies. This study aims to characterize suicide profiles based on trait impulsivity and related factors.

Data from the FRieNDS project (Factores de Riesgo en Defunciones por Suicidio – Risk Factors in Suicide Deaths), a psychological autopsy study of 408 suicide deaths, were used. After determining the optimal number of clusters via stability analysis through agglomerative nesting, a final cluster analysis was performed on 391 valid suicide deaths (defined as cases with no missing data on the variables used for clustering) using k-means on a lower-dimensional representation of the data encoded by an autoencoder. Key clustering variables included sex, impulsivity (Barratt Impulsivity Scale-11), aggression, intent to die, previous history of suicide attempts, history of substance abuse, psychotic and affective disorders, and the presence of a depressive episode at the time of death.

We identified three clusters: (1) Impulsive-aggressive (29.8%), characterized by high rates of Cluster B disorders, substance abuse, more stressful events, and low lethal intent; (2) depressive prior attempters (24.5%), which comprised mostly women and showed greater behavioural changes before death; and (3) non-impulsive/aggressive (45.7%), a group with no clear psychopathological profile, less healthcare contact, and minimal communicated intent to die, despite having few prior attempts.

Our study identified three suicide clusters with varying impulsivity levels, highlighting the need for tailored interventions and community-level research for better suicide prevention strategies.

Suicidal behaviors (SB) in bipolar disorder (BD) are major adverse outcomes that may influence disease progression. While staging models exist for psychiatric disorders, none include suicide. This study aims to stratify suicidal risk in BD, propose a staging model for SB, and assess its clinical utility.

Participants from the FondaMental Advanced Centers of Expertise for Bipolar Disorder (FACE-BD) cohort were categorized into five stages (St) based on SB: St0 (no suicidal ideation [SI]), St1 (SI but no suicide attempt [SA]), St2a (non-severe/violent SA), St2b (severe /violent SA), and St3 (multiple SAs). Stages were analyzed based on demographic, clinical, cognitive, and biological characteristics using logistic regression.

Key differences emerged between stages. St1 showed longer untreated illness and higher lability and lower functioning than St0. St2a was linked to anxiety, substance use disorders, and longer disorder duration, while male gender and lithium bitherapy were protective. St2b exhibited shorter untreated illness and higher childhood trauma (CTQ) scores, with male gender and alcohol use as risk factors. St3 was associated with BD-II, alcohol use, longer disorder duration, and more depressive episodes, but less anxiety. No biochemical or cognitive differences were found across stages. The model was significantly associated with SA occurrence (LRT = 28.74, p < 0.0001).

This staging model for suicidality in BD provides a multifaceted approach to risk stratification and predictive insights, although further refinement is needed.

Psychotic disorders, including schizophrenia (SZ), schizoaffective disorder (SZA), bipolar disorder (BD), psychotic depression (PD), and other nonaffective psychoses (ONAP), are associated with increased risk of suicidal acts. Few studies have compared suicidal act prevalence across psychotic disorders using both self-report and register data. The impact of hospitalization duration on subsequent suicidal acts is unclear.

We used data from the SUPER-Finland study, involving 7067 participants with register-based ICD-10 diagnoses of psychotic disorders (SZ, SZA, BD, PD, ONAP). Lifetime suicidal acts were identified through self-report and register-based records of intentional self-harm events requiring medical treatment. Associations between diagnostic categories and suicidal acts were assessed using logistic regression, adjusted for sex, duration of illness, socioeconomic status, childhood abuse, and substance use. Survival analysis was used to examine the impact of hospital stay length on postdischarge self-harm.

Lifetime suicide attempts (39.1%) and register self-harm (19.3%) were prevalent. of those with self-reported suicide attempts, 40.5% also had register-based self-harm. Self-harm and suicide attempts were significantly more prevalent in SZA, BD, and PD compared to schizophrenia, with large differences between groups (24.1–46.4% for suicide attempts, 11.1–23.9% for self-harm). Adjusted odds of self-harm were higher for disorders with a mood component. Shorter hospitalizations were associated with an elevated hazard ratio for subsequent self-harm.

Prevalence of register-based self-harm and self-reported suicide attempts differ markedly. Suicidal acts are common in psychotic disorders, particularly in those with a mood component. Very short inpatient stays may not be adequate in these disorders.

Completed suicide (CS) is among the leading causes of death. Suicide attempts (SAs) are more frequent and are a significant contributor to overall morbidity. However, there is only few data on community-based suicide prevention using systemic approaches. We have implemented a communal suicide prevention program and tested whether it reduced the number of SA and CS.

“FraPPE” comprised measures proposed by previous studies: low-threshold outpatient services, a SA postvention, a hotline targeting individuals with suicidal intent, qualification of gatekeepers and general practitioners, and a campaign to refer SA cases to psychiatric services and antistigma campaigns. The intervention lasted for 25 months.

For CS, 7.7 cases per month were recorded during baseline, compared to 9 cases per month in the intervention phase. For SA, the numbers were 39.2 and 40.7, respectively. These numbers did not differ significantly. The most frequent diagnostic group was affective disorders, followed by substance use disorders. The average age was lower in the SA group. More males committed suicide (p < 0.001), whereas the sex ratio was balanced in SA.

The communal suicide prevention measures implemented in FraPPE did not reduce the number of suicides and SAs. This should be interpreted with caution, as a number of prevention measures were already executed in the region. Also, data were confounded by the COVID-19 pandemic. Our awareness campaign may also have reduced the dark field, leading to increased reporting. We thus propose to enact registries on suicidal behaviors, to obtain better data and develop new preventive measures.

Adolescents are at a heightened risk of suicide reattempts following hospital discharge, but few evidence-based interventions exist. This study evaluated the efficacy of the self-awareness of mental health (SAM) program combined with treatment as usual (TAU) versus TAU alone in reducing reattempts among high-risk adolescents.

A randomized clinical trial was conducted across nine Spanish hospitals (January 2021–March 2024) with 261 adolescents (12–17 years) who had attempted suicide within the last 15 days. Participants were assigned to SAM + TAU (n=128) or TAU (n=133), with 12-month follow-up. The primary outcome was suicide reattempts within 12 months; secondary analyses examined time to reattempt and associated risk factors.

After 12-months, no significant differences were found in reattempt rates [22.6% (SAM) versus 27.8% (TAU); OR=0.610, 95%CI (0.321–1.151), p=0.127] or time to reattempt [HR=0.606, 95%CI (0.390–1.021), p=0.060]. In SAM, attentional impulsivity emerged as a significant risk factor [HR=1.126, 95% CI (1.004–1.263), p=0.043], while nonplanning impulsivity was protective [HR=0.878, 95%CI (0.814–0.948), p<0.001]. In TAU, increased suicide risk was linked to suicidal intentionality [HR=1.341, 95%CI (1.009–1.782), p=0.044] and more prior attempts [HR=1.230, 95%CI (1.039–1.457), p=0.016]. Conversely, fewer psychiatric diagnoses emerged as a protective factor [HR=0.821, 95%CI (0.677–0.996), p=0.045].

While no significant differences were found between groups, SAM identified important psychological factors influencing suicide risk. These findings provide a foundation for targeted interventions to prevent reattempts in adolescents.

Decisional capacity is an important requirement for assisted suicide, which has been legalized in an increasing number of countries. While several instruments have been developed over the past few decades to assess the capacity to consent to treatment, little is known about their applicability to assessing capacity in the context of requests for assisted suicide.

Systematic review of instruments assessing decisional capacity published up to March 2024. Data concerning criteria for determining decisional capacity, psychometric properties, and other aspects were extracted from all instruments included. Selected instruments were analyzed regarding their applicability to requests for assisted suicide.

We identified 23 instruments assessing the capacity to consent to treatment. There is considerable heterogeneity regarding the criteria utilized for assessing decisional capacity and their operationalization. Next to more cognitive abilities, some instruments directly incorporated emotions and values. Five instruments were assessed for applicability to requests for assisted suicide. The framing of decisional capacity within the context of disease and treatment options frequently limits the application of instruments to assess decisional capacity in the context of requests for assisted suicide.

No instrument could be identified that could be applied to assessing decisional capacity in the context of requests for assisted suicide without any limitations or without necessitating adjustments. Further normative and empirical work is required for developing an instrument that could be applicable in this context.

Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can treat suicidal symptoms; however, the effects of rTMS on suicidal ideation (SI) in late-life depression (LLD) have not been well-characterized, particularly with theta burst stimulation (TBS).

Data were analyzed from 84 older adults with depression from the FOUR-D trial (ClinicalTrials.gov identifier: NCT02998580), who received either bilateral standard rTMS or bilateral TBS targeting the dorsolateral prefrontal cortex. The primary outcome was change in the Beck Scale for Suicide Ideation (SSI). The secondary outcome was remission of SI. Demographic, cognitive, and clinical characteristics that may moderate the effects of rTMS or TBS on SI were explored.

There was a statistically significant change in the total SSI score over time [χ2(7) = 136.018, p < 0.001], with no difference between the two treatment groups. Remission of SI was 55.8% in the standard rTMS group and 53.7% in the TBS group. In the standard rTMS group, there was no difference in remission of SI between males and females, whereas remission was higher in females in the TBS group (χ2(1) =6.87, p = 0.009). There was a significant correlation between time to remission of SI and RCI z-score for D-KEFS inhibition/switching [rs = −0.389, p = 0.012].

Both bilateral rTMS and bilateral TBS were effective in reducing SI in LLD. There may be sex differences in response to TBS, with females having more favorable response in reducing SI. There may be an association between improvement in cognitive flexibility and inhibition and reduction of SI.

The focus of suicide research changes from traditional risk factors to acute warning signs. Patient self-reported suicidal ideation (SI) is not a reliable measure of acute suicide risk. Presuicidal syndromes such as suicide crisis syndrome (SCS) attempt to describe measurable syndromes based on warning signs other than SI.

Seven hundred and ten acutely admitted patients were included in the study. Identification of symptoms describing the five components of SCS was done by performing a retrospective text analysis of the patient records (electronic medical records). Patients were grouped according to high or low level of SCS symptoms. We performed statistical tests for group differences in demographics, traditional risk factors, and clinical variables, including agitation assessed by the Positive and Negative Symptom Scale-Excited Component (PANSS-EC).

Seventy-two patients had high levels of SCS symptoms. They reported less SI the last month before admission; suicidality was less relevant for referral, the intake suicide assessment more often concluded with high suicide risk, they were more often referred and admitted involuntarily, and they had higher total scores on PANSS-EC.

The individual SCS symptoms may provide useful information in the evaluation of acute suicide risk at intake. A high level of SCS symptoms suggests more severe conditions. The lower reports among high-level than low-level SCS patients of self-reported SI last month before admission, shows the limitation of using SI as a warning sign. The association between the level of SCS symptoms and PANSS-EC total score suggests that agitation could give valuable additional information for suicide risk assessments.

Individuals who die by suicide tend to share more characteristics with those who attempt suicide using violent methods than with those who employ nonviolent means. To date, limited research has been published on the demographic characteristics of individuals who engage in violent suicide attempts.

This study aimed to examine trends in the characteristics of violent suicidal behavior in comparison to nonviolent suicidal behavior.

Patients included in the study were consecutively admitted between 2016 and 2021 to the Dr. Manninger Jenő National Trauma Center and the Psychiatric and Toxicology Wards of Péterfy Sándor Hospital in Budapest, Hungary, for medical treatment following violent or nonviolent suicide attempts. Differences in demographic characteristics, risk factors associated with violent suicidal behavior, and methods of attempt were analyzed using Chi-square tests and logistic regression models.

A total of 298 inpatients (46.1% male, 53.9% female), aged between 18 and 65 – representing the economically active population – were included in the study. The sample comprised 145 individuals who attempted suicide using nonviolent methods (73% female, 27% male) and 153 who used violent methods (64.7% male, 35.3% female). Of the total sample, 22 individuals (12.1%) died during treatment due to severe medical complications. Among male attempters, the highest proportion fell within the economically active age range of 18–55 years, whereas among female attempters, the 18–35 age group represented the highest proportion. The most common violent methods, in descending order of frequency, were stabbing (49.7%), jumping from a height (29.8%), and jumping in front of a train (7.7%). The most frequently diagnosed psychiatric disorders among the sample were major depressive disorder (42.2%), anxiety disorders (44.9%), and bipolar disorder (12%). The leading reported motives for violent suicide attempts, in decreasing order of frequency, were marital conflict (32.4%), divorce/separation/break-up (30.2%), and severe or chronic somatic illnesses (12%). When comparing the two subgroups, the strongest risk factors associated with violent suicide methods included male gender, older age, and residence in the capital city.

Previous studies suggest that risk factors are largely indistinguishable between individuals who engage in violent versus nonviolent suicide attempts. However, individuals who attempted suicide using violent methods exhibited characteristics more closely aligned with those who died by suicide than with the remainder of the sample. The majority of data in this study were collected during the COVID-19 pandemic – a period marked by multiple overlapping crises – which may have played a disproportionately large role in the emergence of suicide risk.

Exposure to Adverse Childhood Experiences (ACEs) might increase the risk of suicide behaviors in the general adult population, while this association in individuals with affective disorders remains less characterized.

A comprehensive search was conducted in MEDLINE, PsycINFO, CINAHL, Web of Science, Scopus, and PubMed up to July 10th, 2024. Observational studies that compared the risk of suicide behaviors in individuals exposed and unexposed to ACEs were included. Pairwise random-effects meta-analyses were conducted, and the certainty of evidence was assessed with validated criteria.

A total of 41 studies from 17 countries, comprising 19,588 participants, were analyzed. The main findings indicated a significant association between ACEs and suicidal behaviors, with an odds ratio (OR) of 1.98 (95% confidence interval [CI] 1.74–2.26), and a “highly suggestive” strength of association. This was consistent across diagnostic subgroups (i.e., Major Depressive Disorders, Bipolar Disorders, and mixed diagnoses). The association was confirmed for any ACE, with sexual abuse being the most frequently reported and showing the highest risk (OR 2.24; 95% CI 1.90–2.64), for suicidal ideation (OR 2.16; 95% CI 1.42–3.29), and for suicide attempts (OR 1.95; 95% CI 1.70–2.25), while death by suicide and non-suicidal self-injury were underreported. Meta-regression analyses did not suggest potential moderators, though underreporting was noted.

This meta-analysis shows that exposure to ACEs nearly doubles the risk of suicide behaviors in individuals with affective disorders, warranting the targeted clinical, research, and policy measures to timely address this global mental health issue.

The neurobiological basis of suicidal behaviour remains poorly understood. However, emerging evidence suggests that inflammation and vascular homeostasis factors may play a role in its pathophysiology. Childhood trauma, through immune system dysfunction and increased risk of suicidal behaviours, might influence these associations. This study examined the relationships between immune-inflammatory and vascular homeostasis-related markers and their interaction with childhood trauma in relation to a history of suicide attempts in individuals with depression.

A total of 328 patients with major depression were recruited: 166 with a history of suicide attempts and 162 without. Using multivariate binary logistic regression models adjusted for cofounders, we examined the associations between childhood trauma, levels of platelet-related immune markers (serotonin, MCP-1, TSP-1, TSP-2, PDGF-AB, PDGF-BB), and suicide attempt history. Independent associations between PDGF-BB, childhood trauma, and suicide attempts were further assessed using interaction models. Stratified sensitivity analyses based on childhood trauma history were also conducted.

Childhood trauma consistently emerged as associated with suicide attempts across all models. Among the measured biomarkers, higher TSP-2 levels were associated with a suicide attempt history, independent of childhood trauma. Meanwhile, while PDGF-BB alone was not directly linked to suicide attempt history, the interaction analysis revealed that individuals with lower PDGF-BB levels and more severe childhood trauma were more likely to have attempted suicide.

TSP-2 and PDGF-BB are potential biomarkers linked to suicide attempts, with distinct roles in the interplay between biological processes and early-life adversity. These insights can inform the biomarker-informed development of tailored prevention and treatment strategies.

Improving media adherence to World Health Organization (WHO) guidelines is crucial for preventing suicidal behaviors in the general population. However, there is currently no valid, rapid, and effective method to evaluate the adherence to these guidelines.

This comparative effectiveness study (January–August 2024) evaluated the ability of two artificial intelligence (AI) models (Claude Opus 3 and GPT-4O) to assess the adherence of media reports to WHO suicide-reporting guidelines. A total of 120 suicide-related articles (40 in English, 40 in Hebrew, and 40 in French) published within the past 5 years were sourced from prominent newspapers. Six trained human raters (two per language) independently evaluated articles based on a WHO guideline-based questionnaire addressing aspects, such as prominence, sensationalism, and prevention. The same articles were also processed using AI models. Intraclass correlation coefficients (ICCs) and Spearman correlations were calculated to assess agreement between human raters and AI models.

Overall adherence to WHO guidelines was ~50% across all languages. Both AI models demonstrated strong agreement with human raters, with GPT-4O showing the highest agreement (ICC = 0.793 [0.702; 0.855]). The combined evaluations of GPT-4O and Claude Opus 3 yielded the highest reliability (ICC = 0.812 [0.731; 0.869]).

AI models can replicate human judgment in evaluating media adherence to WHO guidelines. However, they have limitations and should be used alongside human oversight. These findings may suggest that AI tools have the potential to enhance and promote responsible reporting practices among journalists and, thus, may support suicide prevention efforts globally.

Studies examining age-stratified risk factors for suicide among individuals with bipolar disorder in different stages of life are scant, possibly because of the insufficient number of suicide cases.

This study investigated suicide mortality rates and risk profiles of suicide mortality stratified by five age groups in individuals with bipolar disorder.

This study identified patients with a diagnosis of bipolar disorder between January 1, 2000, and December 31, 2021, from Taiwan’s National Health Insurance Research Database. The study population comprised 45,211 inpatients diagnosed with bipolar disorder, with 1,370 suicide cases during the study period. We calculated the standardized mortality ratio (SMR) of the bipolar cohort relative to the general population. In the age-stratified nested case–control study, risk set sampling was performed to match 1 suicide case with 10 living controls by age, sex, and the year of first diagnosis. The age-stratified risk associated with demographic characteristics, psychiatric and physical comorbidities was estimated using multivariable conditional logistic regression.

The highest SMR (47.0) for suicide was observed in individuals with bipolar disorder aged <30 years. SMR decreased with age; patients aged >60 years had an SMR of 9.5. Among those younger than 40 years, a higher percentage of unemployment was noted among suicide cases than among controls. A significantly increased risk of the depressive phase of bipolar disorder was noted shortly before suicide mortality among patients with bipolar disorder in all age groups. Drug-induced and alcohol-induced mental disorders were associated with suicide and were highly prevalent in patients aged <30 years. Other forms of heart disease were identified in patients aged <40 years, and pneumonia was detected in the 50–59 years age group.

These findings aid the development of health-care intervention strategies for preventing suicide among patients with bipolar disorder in various stages of life.