Suicide is a leading cause of death in the pediatric population. During the COVID-19 pandemic, children were particularly vulnerable because there were high rates of mental health issues including depression, anxiety, and PTSD. Our objective is to systematically summarize the primary data literature on how suicide attempts in the pediatric population have changed before and after the start of COVID-19 pandemic. On April 8, 2022, we conducted our search on PubMed, PsycINFO, and Embase with the search terms: “(covid) AND ((suicide) OR (self-harm)) AND ((child) OR (pediatric) OR (adolescent)).” The included articles must have primary data regarding suicide attempts before and after the start of the pandemic. Self-harm with potentially lethal method or severe consequences was also included. Only papers on population age 18 and under were included. Our search returned 552 unique entries, and 18 papers were included. Two articles (12%) reported that there was no change. Eight (47%) articles reported a decrease in suicide attempts; among these, 3 (18%) reported significant p values, 4 (24%) had nonsignificant p values, and 1 did not report. Three articles reported an increase in suicide attempts. Of these, 1 reported a significant p value, 1 had a nonsignificant p value, and 1 did not report. Five (29%) noted different trends regarding gender, risk of attempts, age group, and time periods. Two noted no significant change in boys. For girls, an article from Germany found a significant decrease, but an article from Spain found a significant increase. One article found a significant decrease for low-risk attempts and an insignificant decrease for moderate- to high-risk attempts. One found no change in adolescent suicide overall, but a significant increase for ages 17 and 18 years. One article found a decrease of suicide attempts in the first lockdown but an increase in the second lockdown, and no statistical significance was reported. Only a few articles found statistically significant changes in suicide attempts after the start of the pandemic. Around half of the articles found a decrease in suicide attempts. The effect of the pandemic on suicidality was complex. Some possible explanations included the increased availability of telehealth and the increased awareness of mental health during the pandemic.

Identify implantable cardioverter defibrillator (ICD) patients at risk of distress (i.e., depression, anxiety, and ICD concerns) and associated risk factors.First-time ICD patients (n = 1503) from the Danish national DEFIB-WOMEN study completed questionnaires at baseline, 3, 6, 12 and 24 months.Of patients with low scores on distress, only 4%–7.2% experienced an increase in distress during 24 months of follow-up (FU), while 30.5%–52.5% with increased levels were likely to maintain increased levels at FU. Higher education, higher age, female sex, and good physical functioning at baseline were associated with less depression, anxiety and ICD concerns at FU. Previous psychological problems, smoking, Type D personality, NYHA class III-IV – all assessed at baseline – and shocks during FU were associated with depression, anxiety and ICD concerns.Generally, patients' psychological health improved, but patients with increased baseline scores were more likely to have increased scores at FU. We need to be vigilant if patients report elevated distress, particularly if they have depression at baseline, as depression seems more persistent. Given the impact of depression on health-related quality of life and prognosis, they should be screened and monitored closely.

Background: Suicide prevention is limited by the frequent non-planned or impulsive nature of suicidal behavior. For instance, 25-62 % of suicide attempts, occur within 30 min of the onset of suicidal ideation. We aimed to examine frontal brain activity in depressed patients following a suicide attempt and its relationship with the duration of the suicidal process.Methods: We recruited 35 adult patients within three days of a suicide attempt of at least moderate lethality. Duration of the suicidal process was recorded in a semi-structured interview, including suicide contemplation (time from onset of suicidal ideation to decision to kill oneself) and suicide action intervals (time from the de-cision to kill oneself to suicide attempt). Resting state EEG data from AF7, AF8, TP9 and TP10 leads was collected with a portable MUSE 2 headband system. The average frequency values throughout a 5-minute portable EEG recording were extracted for delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz) waves.Results: Delta (r = 0.450, p = 0.021) and theta power (r = 0.395, p = 0.044) were positively correlated with the duration of the suicide action interval. There were no significant correlations of the suicide contemplation in-terval with clinical or EEG measures. Patients with suicide action interval shorter than 30 min showed lower delta power (U = 113, p = 0.049) compared with those with longer duration.Conclusions: Lower theta and delta activity may reflect hindered cognitive control and inhibition in impulsive suicide attempters. Portable EEG may provide a valuable tool for clinical research and in the management of acutely suicidal patients.

Abstract Prolonged length of stay in emergency departments (EDs) for patients with a psychiatric chief complaint is a widespread problem. Prolonged stays can lead to adverse outcomes and poor quality of care. We sought to improve quality of care for patients in the medical ED who needed psychiatric care. To identify the areas of weakness, we queried the ED staff via an online survey about the perception of the challenges working with our Comprehensive Psychiatric Emergency Program (CPEP), which is located adjacent to and works closely with the medical ED providing psychiatric consultation. We identified several action steps and used the Plan-Do-Study-Act methodology for implementation. We reported a reduction in time to complete consultations and improved communication between CPEP and the medical ED staff.

It has been hypothesized that individuals less sensitive to pain could be at higher risk of suicide. However, data on pain sensitivity in suicide attempters (SA) obtained using experimental procedures are heterogeneous. The aim of this systematic review and meta-analysis was to investigate and compare pain tolerance and threshold in SA (patients with lifetime history of suicide attempt), non-attempters (psychiatric controls, PC), and healthy controls (HC). A random effects meta-analysis was used to estimate the standardized mean differences using data from 16 studies that compared physical pain tolerance and threshold in SA and PC or HC. Pain tolerance and threshold were not significantly different in SA and PC. However, pain tolerance, but not threshold, was higher in SA than HC. Our findings do not support the hypothesis of an altered pain perception related as a trait for suicidal vulnerability, but rather suggest altered pain perception related to psychiatric vulnerability.

Several reports indicate either increased or decreased pain sensitivity associated with psychiatric disorders. Chronic pain is highly prevalent in many of these conditions. We reviewed the literature regarding experimental pain sensitivity in patients with major depression, bipolar disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder, panic disorder, obsessive-compulsive disorder and schizophrenia. Electronic searches were performed to identify studies comparing experimental pain in patients with these conditions and controls. Across 31 depression studies, reduced pain threshold was noted except for ischemic stimuli, where increased pain tolerance and elevated sensitivity to ischemic pain was observed. A more pervasive pattern of low pain sensitivity was found across 20 schizophrenia studies. The majority of PTSD studies (n = 20) showed no significant differences compared with controls. The limited number of bipolar disorder (n = 4) and anxiety (n = 9) studies precluded identification of clear trends. Wide data variability was observed. Awareness of psychiatric patients' pain perception abnormalities is needed for active screening and addressing physical comorbidities, in order to enhance quality of life, life expectancy and mental health.

Leave passes provide authorized leave for hospitalized patients from a psychiatric inpatient unit. Although providing day passes was once a relatively common practice, there are relatively few data describing their safety and efficacy. This descriptive study examines the use of leave passes in an adult inpatient unit at a university hospital between 2017 and 2021, with attention to reasons for granting the day pass, duration, and outcome of the pass. During the study period, 10 patients with primary psychotic or mood disorders received 12 passes for housing coordination, COVID-19 vaccination, or major family events. There were no fatalities or abscondments. One patient experienced severe agitation and engaged in nonsuicidal self-injurious behavior. A second patient showed mild, redirectable psychomotor agitation upon return to the unit. The remaining 10 passes were uneventful. Our findings support the view that patients with diverse diagnoses can safely be provided leave from an inpatient setting with adequate planning and support, yielding a low incidence of adverse events.

Abstract Leave passes provide authorized leave for hospitalized patients from a psychiatric inpatient unit. Although providing day passes was once a relatively common practice, there are relatively few data describing their safety and efficacy. This descriptive study examines the use of leave passes in an adult inpatient unit at a university hospital between 2017 and 2021, with attention to reasons for granting the day pass, duration, and outcome of the pass. During the study period, 10 patients with primary psychotic or mood disorders received 12 passes for housing coordination, COVID-19 vaccination, or major family events. There were no fatalities or abscondments. One patient experienced severe agitation and engaged in nonsuicidal self-injurious behavior. A second patient showed mild, redirectable psychomotor agitation upon return to the unit. The remaining 10 passes were uneventful. Our findings support the view that patients with diverse diagnoses can safely be provided leave from an inpatient setting with adequate planning and support, yielding a low incidence of adverse events.

Effective suicide prevention is limited by the non-planned or impulsive nature of suicidal behavior. Approximately 50% of individuals who attempt suicide, do so within 10 minutes of suicidal ideation onset. We aimed to examine brain activity following a recent suicide attempt and its relationship with the duration of the suicidal process.

While suicide prevention is a national priority, particularly among service members and veterans (SMVs), understanding of suicide-related outcomes remains poor. Person-centered approaches (e.g., latent class analysis) have promise to identify unique risk profiles and subgroups in the larger population. The current study identified latent subgroups characterized by prior self-directed violence history and proximal risk factors for suicide among suicide attempt survivors, and compared subgroups on demographics and most-lethal attempt characteristics. Participants included civilians and SMVs reporting lifetime suicide attempt(s) (n=2,643) from the Military Suicide Research Consortium. Two classes emerged from Common Data Elements: suicide attempt and non-suicidal self-injury frequency, suicide attempt method, perceived likelihood of future suicide, suicide disclosure, suicide intent, and perceived and actual lethality of attempt. A Higher-Risk History class was characterized by greater intent to die, certainty about attempt fatality and method lethality, belief injury would be medically unfixable, and likelihood of prior non-suicidal self-injury. A Lower-Risk History class was characterized by greater ambivalence toward death and methods. Higher-Risk class members were more likely to be male, older, SMVs, have less formal education, use firearms as most-lethal attempt method, and require a higher degree of medical attention. Lower-Risk class members were more likely to be female, civilian, use cutting as most-lethal attempt method, and require less medical attention for attempts. Findings have implications for risk assessments and highlight the importance of subjective perceptions about suicidal behavior. Further investigation of real-time individual-level is necessary, especially for SMVs who may be at greatest risk for potentially lethal suicidal behavior.

Introduction: This study compares rates of depression, suicidal ideation, and burnout among resident/fellow and attending physicians in orthopaedic surgery to other specialties during height/end of the first wave of the coronavirus disease 2019 (COVID-19) pandemic at our institution. Main outcomes and measures included suicidal ideation, Patient Health Questionnaire for Depression (PHQ-9) scores for depression, and 2 single-item measures for emotional exhaustion and depersonalization. This study provides valuable information regarding orthopaedic surgeon mental health during world crises. Methods: This is a cross-sectional survey-based study of resident, fellow, and attending physicians from 26 specialties during and after the first wave of the COVID-19 pandemic at our institution from April 24, 2020 to May 15, 2020. The survey contained 22 items. This includes consent, demographics and general data, 2 single-item questions of emotional exhaustion and depersonalization, and the PHQ-9. Subjects were eligible if they were a resident/fellow or attending physician at our institution. Results: The response rate for the study was 16.31%. Across all specialties rates were 6.2% depression, 19.6% burnout, and 6.6% suicidal ideation. The results for orthopaedic surgeons are as follows: 0% tentative diagnosis of depression, 3.8% suicidal ideation, and 4% burnout. Anesthesiology had the highest rate of depression (14.3%). Internal medicine and other non-surgical specialties had the highest rate of suicidal ideation (10.2%). Orthopaedic surgeons were significantly more likely to achieve work–life balance and experience less burnout than anesthesiologists and pediatricians. Discussion: Depression, suicidal ideation, and burnout continue to affect physicians across all specialties. These issues are amplified in light of crisis. Job satisfaction and rigorous training may be protective factors that allow orthopaedic surgeons to adapt to novel clinical settings under stress when compared to anesthesiologists and pediatricians. Resilience training and stress management strategies should continue to be investigated to better prepare physicians for world crises.

Abnormalities in pain processing have been observed in patients with chronic pain conditions and in individuals who engage in self-harm, specifically nonsuicidal self-injurious behaviors (NSSI). Both increased and decreased pain sensitivity have been described in chronic pain patients, while decreased pain sensitivity is consistently observed in individuals with NSSI. The objective of the study was to identify the differential effects of chronic pain and NSSI on experimental pain sensitivity, specifically pressure pain threshold, in depressed patients. Moreover, the role that hopelessness may play between depression severity and pain sensitivity was also examined. Depressed patients with and without chronic pain, and with and without lifetime self-harm behaviors were analyzed into four groups. Group 1 (N = 42) included depressed patients with both Chronic pain ( +) and Self-harm ( +), Group 2 (N = 53) included depressed patients with Chronic pain ( +) but no Self-harm (-), Group 3 (N = 64) included depressed patients without Chronic pain (-), but Self-harm ( +), and Group 4 (N = 81) included depressed patients with neither Chronic pain (-) nor Self-harm (-). Healthy controls (N = 45) were also recruited from the community. Depressed patients with both Chronic pain ( +) and Self-harm ( +) reported higher pressure pain threshold measures when compared with the other groups. Mediation analysis indicated that hopelessness mediates the relationship between depression severity and pressure pain threshold. Our findings suggest that a multiprong approach including adequate mental health services and pain control for depressed patients with comorbid chronic pain and nonsuicidal self-harm is needed to yield effective outcomes.

Suicide risk assessment is a subjective process and remains a clinical challenge in psychiatry. We aimed to examine physicians' characteristics that influence management of acutely suicidal patients. In a cross-sectional design, we performed an anonymous internet survey of psychiatry residents and attendings from four academic centers. Gender, years of experience, practice setting, prior patient suicide, and personal exposure to suicide were characterized. Participants were presented with three clinical vignettes and asked to rate suicide risk and clinical disposition. The relationship between responses to the vignettes and physician characteristics were examined with generalized linear models. Fifty-four residents and 49 attendings completed the survey. Four (7%) residents and 24 (49%) attendings had patients die by suicide, whereas 32 (59%) and 36 (74%), respectively, knew somebody outside their practice who died by suicide. Among residents, lower rating of acute suicide risk was associated with prior exposure to non-patient suicide. Less hospitalization chosen by attendings was associated with greater perceived difficulty of suicide risk assessment. In the combined resident and attending sample, less proneness to hospitalize was associated with number of previous patients die by suicide and with outpatient practice. Our results suggest that previous exposure to suicide is associated with more risk-averse management.

Abnormalities in resting-state electroencephalogram (EEG) activity and pain processing have been observed in depression and suicidal behavior. Frontal region asymmetry in resting-state alpha band activity has been associated with impaired brain functioning. Aberrations in resting-state EEG activity have been described in depressed patients; however, it is unclear how it compares to acutely suicidal patients. In this study, we aimed to examine the differences in frontal alpha asymmetry and psychological pain between acutely suicidal patients and non-suicidal depressed patients. ErratumBiological PsychiatryVol. 90Issue 11PreviewErratum to Conference Abstract: “Increased Frontal Alpha Asymmetry and Suicidal Ideation Severity in Acutely Suicidal Patients,” by Kim et al. (Biol Psychiatry 2021; 89(9S):S349); https://doi.org/10.1016/j.biopsych.2021.02.870 . Author Jaisy Lau’s name was inadvertently misspelled as Jaisy Lu. The error has now been corrected. Full-Text PDF

Fontecha-Hernandez, Jeisson MD; Hristidis, Vasilis C. BA; Pecoraro, Philip MD; Cáceda, Ricardo MD, PhD Author Information

Abstract Objective Effective suicide prevention is hindered by a limited understanding of the neurobiology leading to suicide. We aimed to examine the association between changes in the experience of pain and disturbances in sleep quantity and quality in patients with elevated risk for suicide. Methods Three groups of adult depressed individuals, including patients following a recent suicide attempt (n = 79), patients experiencing current suicidal ideation (n = 131), and patients experiencing depression but no suicidal ideation or behavior in at least 6 months (n = 51), were examined in a case-control study for sleep quantity and quality, physical and psychological pain, pressure pain threshold, suicidal ideation, and recent suicidal behavior. Results Sleep quality, physical and psychological pain were positively associated with suicidal ideation severity. In both cases in which sleep quality was added to a model with either physical or psychological pain, physical or psychological pain became more significantly associated with suicidal ideation severity. Pressure pain threshold was elevated in patients suffering from any type of insomnia. There was no significant association between pressure pain threshold and suicidal ideation severity. Conclusions The impact of these findings lies in the identification of both psychological and physical pain, and sleep quality as potential biological mechanisms underlying suicidal risk. HIGHLIGHTS We assessed the association between pain and sleep quality in suicidal patients. Sleep quality, physical and psychological pain were associated with suicide risk. Pain perception may mediate the progression to suicidal behavior.