To examine temporal and seasonal variation in presentations of suicidality and self-harm to a large tertiary emergency department (ED) and to investigate the association of environmental variables, including temperature, sunshine hours, precipitation, and photoperiod with daily presentation rates.

Daily presentations for suicidality or self-harm to a tertiary hospital ED from July 2016 to December 2024 were analysed using Poisson regression. Analyses for meteorological variables were controlled by day of week and month of year.

Mean daily presentations increased over time, with greater rates in the early week (Monday–Wednesday) and lowest on weekends. The rate of change of photoperiod lagged by 7 or 14 days was associated with a 5% increase in presentations per additional 1-minute/day day length (p = 0.048; p = 0.032), translating to a 20–21.3% increase in daily presentations in the weeks after the Spring Equinox. Sunshine hours were not associated with change in rate of presentations. Cumulative rainfall became significant at 14- (p = 0.008) and 30-day cumulative ranges (p < .001). Higher temperatures were associated with greater presentations, with 2.2% higher presentations per 1°C increase of mean (p < .001) or minimum temperature (p < .001).

These data support international literature of associations between suicidal behaviour and increased temperature, precipitation and rate of change of photoperiod, with greater presentations occurring in the weeks after the Spring Equinox. Along with findings of excess presentations during the early weekdays, resource planning should consider these seasonal variations in service demand.

Older people have higher rates of death by suicide, and both self-harm and suicidal ideation are major risk factors for suicide. There is limited data relating to this group internationally.

The objective of this study was to identify the clinical and sociodemographic variables associated with psychiatric admissions for older people who present with self-harm and suicidal ideation to emergency departments in Ireland.

This is a cohort study of older people in Ireland, utilising data collected by the National Clinical Programme for Self-Harm and Suicide-Related Ideation (NCPSHI). It is a national data-set including anonymised data from all participating emergency departments in Ireland, comprising 72 810 presentations over 5 years (2018–2020). We examined the characteristics of people aged over 60 presenting with self-harm and suicidal ideation (n = 4866). The variables associated with suicidal ideation and behaviours were explored using multivariable analysis.

Nationally, 7% of the patients presenting were aged over 60 years. One-quarter (26.8%) of older people presenting with self-harm required psychiatric admission (16.3% all-ages). On multivariable analysis, the relationship between self-harm and psychiatric admission was not statistically significant (reference group was those with suicidal ideation), after controlling for gender, year of presentation, substance use and need for medical admission odds ratio 0.977 (CI0.936–1.020).

Our results outline the characteristics of older people presenting to Irish emergency departments with self-harm and suicidal ideation, which are associated with psychiatric admission. Further research is needed to understand the factors driving these presentations and to tailor our services to meet the needs of older people.

People who are agitated, confused or distressed seldom receive holistic care within acute general hospitals. Unmet needs relating to conditions such as mental illnesses, learning disabilities or dementia can contribute to patient behaviours which staff find challenging to manage (e.g. self-harm). Enhanced observation, involving one-to-one care and monitoring, is a restrictive intervention often used to manage these presentations. The characteristics and outcomes of high-quality enhanced observation in this setting remain ill-defined, compromising quality and safety.

To understand what constitutes high-quality, safe enhanced observation in an acute general hospital for patients presenting with agitated, confused or distressed behaviours.

A systematic review was performed, involving searches of five bibliographic databases, hand-searching, and forward and backward citation searching. Data describing the characteristics of high-quality, safe enhanced observation practice were eligible and included in a framework-based synthesis. Quality and safety outcomes were summarised thematically. Studies were appraised for quality, and data interpretation was shaped by lived experience experts.

Fifty studies were included. Enhanced observation practice was influenced by individual staff members (e.g. attitudes), teams (e.g. teamwork fluency) and wider organisational factors (e.g. leadership, organisational culture). The quality and safety problems identified included self-harm, aggression and staff neglect of caring responsibilities during enhanced observation.

Findings on the characteristics and outcomes of high-quality, safe enhanced observation provision should inform the development of evidence-based guidance to support improved, standardised practice in acute general hospitals. Evidence gaps with respect to patient experiences of enhanced observation and trauma-informed approaches to its delivery warrant urgent attention.

Responsible media reporting of suicide is a population-level suicide prevention intervention, yet there is no experimental evidence from low-income settings.

We assessed the effects of exposure to educative suicide prevention content and stories of surviving a suicide crisis in the print media on reducing suicidality in India.

A three-arm randomised controlled trial (Clinical Trials Registry of India, ref: CTRI/2022/09/045439) was conducted in Chennai, India, between August 2023 and March 2024. Participants were young adults (18–29 years), recruited through social media advertisements, randomised 1:1:1 to a control group and two intervention groups. Data were analysed during June–September 2024. All three groups were exposed to three 600-word purpose-designed Tamil-language print media articles on digital tablets. Intervention group 1 was exposed to three print media articles containing educative suicide prevention content. The same articles given to intervention group 2 were modified to contain brief accounts of young adults who had coped with experiences of suicidal ideation. The control group was exposed to three print media articles on diabetes. Suicidal ideation was measured using the 23-item Survival and Coping Beliefs subscale of the Reasons for Living Scale at baseline, post-test and 14-day follow-up.

Of 375 participants, randomisation resulted in 125 being assigned to the control group and 124 and 126 to intervention groups 1 and 2, respectively; 16 were lost to follow-up. At post-test, participants randomised to intervention group 1 demonstrated small improvements in suicidal ideation at post-test (standardised mean difference (SMD) = 0.15, p = 0.019) and follow-up (SMD = 0.17, p = 0.038). Larger effects were observed among participants with greater vulnerability (post-test, SMD = 0.25, p = 0.039; follow-up, SMD = 0.32, p = 0.023). There were no improvements in suicidal ideation in intervention group 2 at post-test, yet a marginal (SMD = 0.16, p = 0.053) effect was observed at follow-up.

Exposure to educative print media articles can result in small improvements in suicidal ideation that would represent a substantial population-level impact.

The integrated motivational–volitional (IMV) model of suicidal behaviour has received growing empirical support, yet few studies have tested its core pathways (defeat → entrapment → suicidal ideation → suicide attempts) in clinical psychiatric adolescent populations. Evidence on volitional moderators influencing the transition from ideation to action remains limited.

This study aimed to (a) test the core pathways of the IMV model and (b) examine whether volitional moderators differentiate between adolescents with suicidal ideation and those who have attempted suicide.

In this cross-sectional study, 203 Danish adolescents aged 13–19 years were recruited from an out-patient child and adolescent psychiatry department, including patients in treatment or referred for initial assessment. Participants completed validated measures assessing IMV constructs. Path analysis tested the core pathways and multinomial logistic regression examined associations between volitional moderators and group membership (no suicidal behaviour, suicidal ideation only and suicide attempt), with Wald tests comparing effects across outcomes.

Findings supported the core IMV pathway, with the entrapment–ideation pathway being weakest. Volitional moderators were more strongly associated with suicide attempts than suicidal ideation, with significant differences confirmed by Wald tests. A dose–response pattern showed increasing likelihood of suicide attempts with greater exposure to volitional moderators; effect sizes differed significantly between ideation (odds ratio 2.21) and attempts (odds ratio 3.94).

Results support the IMV model and highlight the role of volitional moderators in differentiating between suicidal ideation and attempts. These findings support a shift towards theory-informed psychosocial assessment in clinical adolescent populations.

Many people presenting to emergency departments after self-harm do not receive adequate care, even in well-resourced health systems.

To identify patterns of health care service use across two periods: (a) during and (b) up to 1 year after an index emergency department self-harm presentation.

A retrospective population-based cohort study including 4668 individuals aged ≥9 years who presented to the Royal Melbourne Hospital emergency department for self-harm between January 2012 and December 2019. Linked administrative data captured >1.3 million records across primary care, pharmacy, specialist mental and physical health services and emergency departments. Sequential pattern mining identified longitudinal service-use clusters. Multinomial regression explored associations with demographic, clinical, psychosocial and presentation characteristics. Cox proportional hazards models assessed associations between clusters and all-cause and suicide mortality.

Emergency department self-harm presentations triggered short-term increases in multi-sector contacts. However, most (68.7%) reverted to the same service-use cluster observed prior to their index presentation. Suicide risk was highest within 1 year, particularly among those in the specialist mental health services cluster (4.5% of the cohort).

A small subgroup engage intensively with specialist mental health services yet remain at high suicide risk, while one in ten remain disengaged altogether, suggesting that an acute presentation of self-harm often fails to alter patients’ care trajectories long-term. Policy alignment with national recommendations for integrated, community-based care could improve sustained, evidence-based support beyond acute crises.

Globally, suicide is more prevalent in older adults compared with any other age group. Although some research has identified risk and protective factors for suicidal behaviour in older adults, further research is needed to provide an up-to-date overview to inform service delivery.

This study protocol describes mixed-methods research that will examine and identify factors associated with self-harm and suicide in older adults (aged 60 years and older) living in Ireland.

Four stages will be conducted. First, data from the National Self-Harm Registry of Ireland (NSHRI), will be used to examine recent hospital self-harm presentations of older adults, including during the COVID-19 pandemic. Second, a case-series study will examine the adverse life events and psychosocial factors experienced by older adults before dying by suicide, using data from closed coronial files, through the Irish Probable Suicide Deaths Study (IPSDS). Third, risk of suicide following hospital-presenting self-harm will be examined among older adults via data linkage of the NSHRI and IPSDS. Finally, using semi-structured interviews, the service needs of older adults with suicidal behaviour will be explored from the perspectives of older adults, carers and healthcare practitioners.

A comprehensive understanding of adverse events and psychosocial factors associated with the suicidal behaviour of older adults is needed to inform service provision. This proposed research is aligned with (inter)national priorities, mental health promotion and suicide reduction policies. It aims to address gaps in mental healthcare interventions for older adults at risk of suicide.

Homelessness is increasing and associated with poor mental health (MH). Few studies have examined how experiences of homelessness and sexual identity intersect to effect MH. We used an intersectional approach to examine MH inequalities related to sexual identity and past homelessness in a nationally representative private household sample, and whether associations were explained by discrimination.

Analysis of the 2007 and 2014 Adult Psychiatric Morbidity Surveys included 10,428 individuals aged 16–64 (58% female/3.8% non-heterosexual). The Clinical Interview Schedule-Revised (CIS-R) identified common mental disorders (CMDs). Self-harm, attempted suicide, alcohol dependence, substance use, sexual identity, discrimination/bullying, past homelessness and health behaviours were self-reported. Associations between sexual identity and homelessness were examined using multivariable Poisson regression. Prevalence ratios (PRs) for MH and health behaviours by intersectional sexual identity-past homelessness were examined using Poisson regression and adjusted for age, sex, area-level deprivation and further for discrimination/bullying.

Bisexual (adjusted PR [aPR]: 2.52, 95% CI: 1.48–4.29) and gay/lesbian (aPR: 1.76, 0.97–3.19) individuals were more likely to report past homelessness than heterosexual peers. Sexual minority (SM) and heterosexual individuals with past homelessness had higher prevalence of all MH outcomes compared to heterosexual peers without homelessness, with associations strongest in the SM-homelessness group (e.g., CMD: aPR: 2.67 [2.37–3.01] for heterosexual-homeless, aPR: 4.11 [3.00–5.63] for SM-homeless, aPR: 1.82 [1.45–2.28] for SM-not homeless groups), and similarly for depression/self-harm/attempted suicide. Likewise, the SM-homeless group had highest prevalence for drug dependence (aPR, 7.38 [3.15–17.29]) compared to the heterosexual-homeless (aPR, 4.03 [3.00–5.42]) and SM-not homeless (aPR, 2.19 [1.27–3.79]) groups. Adjustment for discrimination and bullying substantially attenuated point estimates, with the greatest attenuation (30–50%) in the SM-homeless compared to the heterosexual-homeless groups.

Individuals with past experiences of homelessness have significantly worse MH than heterosexuals without homelessness, with associations highest in the SM-homeless group. Considering experiencing homelessness and SM identity together identifies a group facing particular adversity, which is often lost when examined separately. Discrimination and bullying explained much of the worse MH in SM- and heterosexual-homeless groups, but especially the former. Investigation into the mechanisms leading to MH inequalities is needed, alongside policies and services to support this group.

In The Netherlands, it is unknown whether the number of youth suicide-related emergency department visits has changed over time. Also, insight is needed in the hospital costs for managing these patients, as a first step toward the economic evaluation of suicide prevention measures.

This study examines (a) changes in emergency department-recorded suicide attempts, suicidal ideation and non-suicidal self-injury in youth, including repeat emergency department visits; and (b) related hospital costs for these patients, from a health insurer perspective.

In this cross-sectional study, data from various sources was combined to identify all youth aged ≤27 years visiting a Dutch inner-city emergency department between 2016 and 2023 for a suicide attempt, suicidal ideation or non-suicidal self-injury. Hospital records were reviewed manually to determine inclusion. Ambiguities were discussed within an expert panel and descriptive analyses, Poisson regression and logistic regression analyses were performed. For a subset of 30 patients, invoiced costs were determined.

The number of suicide attempts increased by approximately 5% annually, peaking in 2022 (n = 172); there were significantly more female patients (71%), and the median age was 21 years. Cases of suicidal ideation showed a similar trend, whereas the number of recorded non-suicidal self-injuries reduced. A total of 28.5% of all patients (n = 281) had one or multiple repeat visits for the above reasons. Median suicide attempt-related costs per case were €930, range €385–€33 473.

Since 2016, an increasing number of youth visited the emergency department of a Dutch hospital after a suicide attempt, but this increase does not seem to continue after 2022. Hospital-invoiced costs differ substantially between patients.

The school environment plays a key role in adolescents’ emotional development and well-being, yet little research has compared self-harm and related psychosocial problems across different secondary school types.

Using data from the Growing Up in Ireland (GUI) longitudinal cohort, this study examined differences in the prevalence of self-harm and psychosocial risk factors across different school types: single-sex versus coeducational, fee-paying versus non-fee-paying, disadvantaged versus non-disadvantaged, and schools with different religious ethos. Multilevel regression models distinguished school-level from individual-level effects.

Almost all variance in self-harm and most of the variance in psychosocial problems associated with self-harm occurred at the individual level. Higher self-harm prevalence in single-sex girls’ schools was accounted for by the greater concentration of girls, who had over twice the odds of self-harm compared with boys (OR 2.1, 95% CI 1.71–2.69). No significant differences in self-harm were found by school socio-economic status or religious ethos. Disadvantaged schools showed higher prevalence in seven of nine psychosocial problems, although only internalising problems and truancy/absenteeism remained significantly associated with disadvantaged schools in the fully adjusted models. Adolescents whose parents reported having a religion were less likely to self-harm (OR 0.62, 95% CI 0.50–0.75).

Although schools are important settings for self-harm prevention, findings indicate that interventions should primarily target individuals and high-risk groups. Girls, in particular, may benefit from supports addressing self-harm. Disadvantaged schools, where well-established psychosocial risk factors for self-harm are more common, may benefit from well-being programmes targeting internalising problems and truancy/absenteeism.

Emergency department mental health practitioners (MHPs) decide onward care for individuals presenting with self-harm or suicidal ideation. However, their experiences and practices in making these decisions remain underexplored.

To synthesise research on MHPs’ experiences and practices in making decisions about onward care for patients presenting to emergency departments with self-harm or suicidal ideation.

We searched six databases (inception to July 2024) for empirical studies of MHPs making care decisions for self-harm or suicidal patients in emergency departments. We used a segregated mixed-methods design, applying narrative synthesis of quantitative data and thematic synthesis of qualitative data.

Eleven studies were included (one quantitative, one mixed-methods, nine qualitative). Narrative synthesis of quantitative data produced two themes: (a) subjective decision-making and variability among MHPs and (b) impact of the institutional mandate to discharge within 4 h on referral outcomes. Thematic synthesis of qualitative data generated five themes: (a) risk-centric culture is anti-therapeutic and shapes defensive practice, scepticism toward patients and burnout; (b) time and environmental pressures impact therapeutic potential of assessments; (c) ‘battling’ to access services: gatekeeping, cycles of repeat attendances affecting patient safety and staff moral injury; (d) strategies to facilitate access and extending care to overcome challenges in the emergency department and (e) potential for training to counter negative attitudes and stereotypes.

Intersecting institutional, systemic and emotional pressures shape MHPs’ practices, undermining assessment quality and access to care. System-level reforms and training should promote relational, compassionate care. Limited quantitative evidence restricted integration, and the review reflects high-income Western settings.

To examine the impact the COVID-19 pandemic in Ireland on symptoms and functioning in individuals across a range of mental health disorders.

A systematic bibliographic search of case reports, cross-sectional and longitudinal studies was conducted between March 12th, 2020, and December 20th, 2024, among studies evaluating the impact of the COVID-19 pandemic on symptoms and functioning for individuals with pre-existing mental health disorders and for those who presented with self-harm or died by probable suicide in the Republic of Ireland. Studies were independently screened by two reviewers according to inclusion and exclusion criteria, with selected variables extracted and summarised. Risk of bias assessments and narrative synthesis of included studies were conducted.

Twenty-eight studies met inclusion criteria. Findings were heterogeneous and disorder specific. An increase in presentations of self-harm, anxiety disorders, and eating disorders to child and adolescent mental health services and emergency departments was noted, with relative stability of symptoms in other cohorts including bipolar disorder and treatment-resistant schizophrenia. Significant symptom deterioration, with poor quality of life and functioning was demonstrated in individuals with emotionally unstable personality disorder both cross-sectionally and longitudinally.

Most people with pre-existing mental disorders did not experience significant exacerbation associated with the pandemic, with exception of those with eating disorders and EUPD.