Transgender and nonbinary (trans) people face elevated risk for suicidal ideation (SI); yet, many do not experience SI, necessitating study of mechanisms contributing to, or buffering against, trans suicide risk. Gender minority stress and resilience theories have been tested cross-sectionally; however, no work has tested these models in the daily lives of suicidal trans adults.

Trans adults with past-month suicidal thoughts or behaviors (N = 47) were enrolled for a virtual research study involving a baseline set of interviews and questionnaires, followed by a 4-week ecological momentary assessment protocol. Ecological momentary assessment surveys were administered six times daily and assessed various minority stressors and momentary SI; each day’s first survey assessed resilience factors. Dynamic structural equation modeling was used to disentangle within- and between-person effects of minority stress and resilience factors on changes in SI.

We observed that interpersonal and intrapersonal minority stressors predicted proximal within-person changes in SI over several hours; however, between-person estimates of resilience did not moderate the minority stress–SI relationship, as argued by extant theory.

Although the sample demonstrated adequate geographic, age, and gender diversity, participants were primarily White, limiting generalizability to racial minority trans people, and those outside the United States. Results suggest that interventions targeting minority stress and resilience factors may be appropriate for suicidal trans people, alongside social and political efforts to address discrimination and other interpersonal harms faced by trans people.

Suicide cases in Malaysia have increased since the COVID-19 pandemic. Stigma towards suicidal individuals is one of the risk factors for suicide, often hindering people from seeking help. Therefore, understanding the multidimensional nature of suicidality and its association with stigma is crucial in Malaysia’s multicultural context. The Stigma of Suicide Scale-Short Form (SOSS-SF) is a brief psychometric tool established to measure stigma towards people who have died by suicide.

To translate the SOSS-SF into Malay and assess the reliability and validity of the translated version.

The SOSS-SF was translated into Malay and subjected to a cross-cultural validation study across three universities in Malaysia (n = 243; 70.4% females). Participants completed an online questionnaire. The reliability of the Malay translation was assessed, and exploratory factor analysis, discriminant validity and measurement invariance were employed to examine the scale’s factor structure.

The Kaiser–Meyer–Olkin (KMO) measure for the Malay translation of the SOSS-SF yielded a highly favourable value of 0.854, with cumulative variance explained of 67.178. The construct validity of the translated version was assessed by factor analysis, and a final version was derived comprising 3 factors and 13 items: Factor 1 Stigma (6 items), Factor 2 Isolation/Depression (4 items) and Factor 3 Glorification/Normalisation (3 items). The final Malay SOSS-SF had acceptable internal consistency reliability (Cronbach’s α = 0.793) and scalar invariance across age groups and gender.

The Malay SOSS-SF has shown linguistic and cultural acceptability through cross-cultural adaptation and validation. It is also deemed a valid and reliable tool for assessing the stigma towards suicide in Malaysia.

Serious incidents, such as patient suicide, profoundly impact clinicians. In mental health settings, these events are uniquely distressing. Despite policy shifts towards learning from serious incidents, many doctors report inadequate support and significant emotional distress. Resident doctors, already vulnerable to burnout and emotional exhaustion, are particularly at risk.

This study aimed to understand resident psychiatry doctors’ experiences of serious incidents. It sought to gather in-depth insights about how resident psychiatrists navigate the serious incident process, and the effect the process has on their professional and personal lives.

A qualitative study recruited 10 participants via email in 1 National Health Service (NHS) trust. Semi-structured online interviews were audio-recorded, transcribed and analysed using Braun and Clarke’s six-phase thematic analysis, employing an iterative, constant comparative approach.

Descriptive characteristics of the participants are reported. Three overarching themes were identified: (a) when the process becomes the experience, with subthemes focusing on how open and transparent the investigation process was, about communication during the process and how doctors felt the process impacted their clinical role; (b) from theory to practice: when training meets reality. Subthemes here reflected on whether resident doctors felt prepared and knowledgeable about the process. There was also focus on the experience itself being a learning opportunity; (c) the emotional undercurrents: trauma, grief and support. Here the subthemes focused on the emotional toll of an incident and investigation, the grief and wider impact of a patient death and lastly, the need for support to resident doctors including supervisor and peer-to-peer support. Themes are reported accompanied by verbatim quotes from participants.

Findings confirm prior studies investigating the negative impact of serious incidents on resident doctors’ well-being and career confidence, highlighting the need for robust support. The study adds to the literature through emphasising the inadequacy of current support and highlights rectifiable issues such as the need for structured peer support and improved supervisor/resident training for emotional and professional complexities. Future research should compare these findings with experiences under the new Patient Safety Incident Framework (PSIRF) system to assess improvements.

Natural disasters can increase the risk of suicidal behavior, particularly in resource-limited settings. We characterized suicidal ideation and attempts before and after Hurricanes Irma and Maria (September 2017) in Puerto Rico using crisis-hotline surveillance data.

We conducted a retrospective descriptive analysis of suicide-related calls to Línea PAS, Puerto Rico’s 24/7 government crisis hotline, from January 2015 through December 2021 (84 months). Monthly counts of suicidal-ideation and suicide-attempt calls were aggregated, stratified by sex and age group, and displayed as a time series with September 2017 as the index event, with exact Poisson and Wilson 95% confidence intervals.

Total suicide-related calls rose sharply about 2 months after landfall, peaking from November 2017 through January 2018 (maximum 4,548 calls in January 2018) before returning toward baseline by February 2018. Working-age adults (21-59 years) and women accounted for most calls. The surge coincided with prolonged power and telecommunications outages and with an independent rise in recorded suicide deaths.

These descriptive, ecological findings are consistent with a substantial mental-health burden following catastrophic hurricanes and coincided temporally with prolonged infrastructure disruption; the design cannot establish causation. They support integrating crisis-hotline-based behavioral-health surveillance and rapid utility restoration into disaster preparedness for climate-vulnerable regions.

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.

Since the full-scale Russian invasion in 2022, health facilities and healthcare workers in Ukraine have been systematically targeted. Despite growing calls to prioritise their mental health, robust evidence on the magnitude of the problem and its determinants remains limited.

To estimate the prevalence of mental health problems among doctors and nurses in Ukraine, and examine their association with key exposures.

We conducted a cross-sectional survey between May and September of 2025, in a non-probabilistic sample of doctors and nurses working in Ukraine. The survey included validated self-report instruments to assess depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and suicidal thoughts, as well as workplace risk factors (bullying, sexual harassment, violent threats, physical violence) and protective factors (social support, purpose and meaning at work). Associations were examined using multilevel regression models with extensive sensitivity analyses, including Bayesian models and survey raking weights.

Among 23 805 respondents, 1 in 3 doctors and 1 in 4 nurses reported symptoms compatible with probable depression, 1 in 4 doctors and 1 in 6 nurses reported symptoms compatible with probable anxiety, and about 1 in 10 doctors and nurses reported suicidal thoughts. Workplace violence – particularly bullying – was strongly associated with depression and anxiety, whereas physical violence showed the strongest association with suicidal thoughts. Purpose and meaning at work were consistently associated with better mental health. Associations were overall high and similar across regions with different levels of active conflicts. Estimates were robust across analytic approaches.

Elevated prevalences and strong associations with workplace factors support a zero-tolerance approach to violence and the implementation of scalable mental health strategies that also strengthen protective factors.

An analysis of coronial inquest data provides contextual information rarely available in routine surveillance systems, including a nuanced understanding of proximal circumstances preceding death of value to mental health services. Inquest records of more than 750 suicides occurring within the South Wales Central Coroner’s jurisdiction between 2016 and 2023 were reviewed, including the COVID-19 pandemic years, to assess the effects of lockdown and social isolation. Detailed information was extracted, including medical records, toxicology, police reports, witness statements and suicide notes.

Several patterns emerged relating to age, gender, method of death, trigger factors, local authority area, and engagement with mental health services. Hanging was the predominant method, particularly among men. Depression was the most common trigger factor, followed by relationship problems, alcohol/drug misuse, health concerns, psychotic illness and bereavement.

Key structural and psychosocial risk factors identified highlighted the need for tailored, context-specific suicide-prevention strategies, with circumstances preceding suicide integrated into public health planning.

Suicide is a leading cause of death among young adults, yet few studies have examined longitudinal trajectories of suicidal ideation and attempts across the academic year in UK university students.

The study aimed to identify demographic and psychosocial factors associated with lifetime suicide risk, examine factors associated with changes in risk trajectories, and evaluate the relationship between suicidal ideation and attempts over an academic year.

Participants comprised 3295 students from 5 UK universities who completed longitudinal surveys in autumn and spring terms 2021–2024 in the Nurture-U study. Suicidal ideation and attempts were assessed with Columbia Suicide Severity Rating Scale items. Demographic, psychosocial and mental health measures were examined as potential risk and protective factors. Regression models with multiple imputation were used, with case–control analyses for smaller subgroups.

Approximately 45.5% of students reported baseline lifetime suicidal ideation and 9.5% reported a past attempt. Factors associated with lifetime suicidal ideation included minoritised sexual orientation or ethnic background, male or gender-diverse identity, previous mental health treatment and adverse childhood experiences. Among students with lifetime ideation at baseline, 61.1% did not report ideation in the spring term, whereas new-onset ideation occurred in 3.5% of participants. Among students with prior ideation only, 1.3% made a suicide attempt during the academic year, whereas 10.5% with prior attempt history made a suicide attempt. Increases in depressive symptoms and rumination were associated with new attempts at follow-up.

Most students experiencing suicidal ideation during university have risk factors before university entry. Suicidal ideation alone showed limited specificity for identifying those most at risk of future attempts, highlighting the importance of targeted support for high-risk groups and ongoing monitoring of symptoms throughout the academic year.

Risk assessment and management are key elements of clinical practice in mental health. Existing literature on risk assessment in mental health has focused more on the predictive validity of tools and less on the clinical utility of tools in daily practice.

To explore risk assessment and management processes, and how clinicians use risk tools in daily practice, across a single health board.

This was a large mixed-methods study in a health authority responsible for the care of 1.3 million people covering a wide range of settings. Data collection involved multiple approaches including staff surveys, focus groups, non-participant observations of team meetings, case-file audits and reviews of incident reports.

Although risk was routinely discussed in team meetings, the risk tool was rarely used to inform decision-making. Barriers to meaningful use of the tool included time constraints, lack of training and perceived lack of relevance. Both staff and carers reported limited involvement of patients and families in risk assessment processes. Case-file audits showed high completion rates of the risk tool but little evidence that it influenced decision-making.

This study demonstrates a significant challenge for services, with clinical teams discussing risk but not using the mandated formulation-based risk tool to do so. This is set against the need for health authorities to demonstrate consistent standards in risk management across specialties and settings and to have a format that makes risk management plans easily available to clinicians unfamiliar with the patient. Further research is required to develop a method of recording risk mitigation strategies that is collaborative and can be easily completed in a clinical setting.

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.

Fixed phone boxes enabling calls to a suicide crisis line have been established at a number of public sites where suicides occur. However, the evidence for the effectiveness of this intervention on suicide deaths is not well established. This study examined the effectiveness of fixed phone boxes by comparing suicide rates during the pre-intervention and post-intervention periods.

Using suicide mortality data from three sites in Australia and three sites in the United States, Poisson regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (95% CI) at each site. Pooled IRR (pIRR) was then calculated for all sites using a random-effects meta-analysis.

IRRs and 95% CIs at each site were: Australian sites A: 1.32 (0.94–1.85); B: 2.45 (1.52–3.94); C: 0.32 (0.08–1.33); United States sites D: 3.28 (1.46–7.35); E: 0.57 (0.17–1.95); F: 1.65 (0.45–6.10). The pooled IRR was 1.46 (0.86–2.49). Between-site heterogeneity was large, I2 = 66.5%.

Contrary to general expectation, these findings indicate that fixed phone boxes do not reliably reduce suicide mortality, with two sites even showing increased rates after installation. Their impact appears highly inconsistent across locations, providing no consistent evidence of benefit. This suggests that additional or alternative interventions are necessary to achieve meaningful reductions in suicide mortality at high-risk locations.

Suicide is a serious public health issue and the leading non-accidental cause of death among adolescents in Spain. Although a previous suicide attempt is the strongest risk factor for a new attempt, studies focused specifically on adolescent reattempters remain scarce. This study aims to identify modulating factors for suicide reattempts in a clinical adolescent population following an index attempt, using network analysis.

We recruited a total of 287 adolescents aged 12 to 17, treated in emergency services after a recent suicide attempt. Data collection involved structured clinical interviews and validated self-report questionnaires assessing sociodemographic, psychopathological, and behavioral variables. Our network analysis explored significant correlations (r ≥ 0.2) between variables and their relative influence on suicidal behavior, with a particular focus on reattempts (1-year follow-up).

Variables related to emotional and behavioral difficulties, childhood trauma, and depressive symptoms were the most central and influential within the network. In contrast, suicide reattempts and their frequency appeared as peripheral nodes with no significant direct associations. Emotional abuse was associated with a higher total number of suicide attempts, and the Self-Awareness of Mental Health intervention was linked to a longer time before reattempt.

This study highlights the complexity of suicide reattempt risk factors in adolescents, emphasizing the importance of indirect interactions rather than isolated predictors. Incorporating standardized self-report tools may enhance clinical assessment and prevention strategies. Through network analysis, this research offers an innovative perspective to understand the multivariate nature of suicide risk in adolescent populations.

In Ireland, data on dual diagnosis (DD) is limited. This study aims to describe the characteristics of deaths among people who both used drugs and had a mental health (MH) condition to better understand DD and to help improve the provision of DD services in Ireland.

Data from the National Drug-Related Deaths Index (NDRDI) was used to identify deaths among people who used drugs and had history of at least one MH condition. Sociodemographic characteristics, risk factors, substance use, MH conditions, and type and cause of death, stratified by sex, were analysed descriptively. Variance by MH condition was examined using cross tabulation.

Between 2019 and 2021, 567 deaths met the inclusion criteria. The majority (67.9%) were men. The mean age was 42 years. The most common drugs used were cocaine (47.6%), heroin (37.4%) and cannabis (36.3%). The most common MH conditions were depressive disorders (52.7%), anxiety disorders (36.7%) and specific personality disorders (16.6%). Misadventure (46.6%) and suicide (27.2%) were the most frequent verdicts recorded. Almost equal proportions of deaths were poisonings (48.9%) and non-poisonings (51.1%). Most poisoning deaths involved an opioid-type drug and/or polysubstances (83.8%).

The NDRDI data enables in-depth description of those who died with DD in Ireland. While it does not provide comparisons with those who survived, given the limited amount of research in this area in Ireland, the data contributes valuable insights into the issue.