El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Antepartum suicidal behaviors are a leading cause of maternal injury and death. Previous research has not investigated associations between antepartum suicidal ideation and perinatal complications. Our study objective was to evaluate the relationship of antepartum suicidal ideation with low infant birthweight, small for gestational age, and preterm birth. A cohort study was conducted among 1,108 women receiving prenatal care in Peru. Suicidal ideation was measured using the Patient Health Questionnaire-9 during pregnancy. Birth outcomes were extracted from medical records. Linear regressions and multivariable logistic regressions were used to estimate were used to investigate associations between suicidal ideation and pregnancy outcomes. The prevalence of suicidal ideation was 8.7%, preterm delivery was 5.7%, low birthweight was 4.4%, and small for gestational age was 3.4%. In an adjusted model, infant birthweight was 94.2 grams lower for mothers with antepartum suicidal ideation (95% CI: −183.0, −5.5, p = 0.037) compared with those without suicidal ideation. After adjusting for confounders including depression, participants with suicidal ideation had a nearly four-fold increased odds of delivering a small for gestational age infant (OR: 3.73; 95% CI: 1.59–8.74). These findings suggest suicidal ideation during pregnancy is associated with adverse perinatal outcomes, especially low infant birthweight. / Revisión por pares

The term “moral injury” has recently been introduced to describe psychopathology resulting from perpetrating or bearing witness to an event that transgresses deeply held moral beliefs, typically in relation to military service. Two studies examined relations between potentially morally injurious events (PMIEs) during military service, self-conscious emotions, and negative mental health outcomes. The potential moderating contributions of social support and psychopathic personality traits on these relations were also assessed. A subset of 40 of the 501 veterans who completed a detailed on-line survey was also interviewed to gain a more thorough understanding of individual experiences. Veterans who had experienced higher numbers of PMIEs were significantly more likely to experience depression symptoms and suicidal ideation, as well as guilt and shame related to their military service, but high levels of social support decreased the likelihood of negative mental health outcomes and subsequent guilt and shame; psychopathic personality traits did not moderate these relations. Qualitative analysis of the interviews confirmed that social support plays a key role in the prevention of moral injury-related symptoms. Social support was crucial to reintegration after deployment for many veterans. Results indicate that adequate social support following PMIEs may reduce the likelihood of psychopathology. Implications of this study and future directions are discussed.

Suicide embodies a considerable but often preventable loss of life. As the second leading cause of death for young people in Canada between the ages of 15 and 24, nearly one-quarter of all annual deaths for this age group are accounted for by those who have died by suicide. Greater still is the prevalence of suicidal behaviour. Annually, suicide and suicidal behaviours across the age span are estimated to cost the Canadian economy $2.2 billion. Given the high personal costs to victims, survivors, and taxpayers, it seems crucial that prevention strategies be implemented to reduce the high rate of suicide and suicidal behaviours, as well as to promote mental health, particularly in youth. The promotion of positive mental health and well-being is especially relevant for youth living in rural areas. Fewer mental health resources are available in rural communities than in urban centres. Moreover, youth living in rural, low population density areas often do not believe that their anonymity and right to privacy would be protected if they were to seek mental health services. The present research was carried out to provide a potential foundation for stimulating mental health promotion and suicide prevention approaches, differing by rural and urban community and by gender, before such concerns emerge. Through a survey of 813 (459 rural youth; 354 urban youth) secondary school youth in Eastern Ontario, we examined the inverse association between suicidal ideation and engagement in extracurricular activities, such as sports, music, drama, or community groups. Who is at greatest risk: It was found that rural youth reported significantly more suicidal thoughts than did urban youth (p < .01). Perceived social support accounted for rural and urban differences, while difficulties coping with daily stressors accounted for gender differences, in self-reported suicidal ideation. Thus, “red flags” for communities at risk could include perceived deficits in social support within a given community, as well as having a number of young females who indicate poor coping with daily stressors. What factors to target: Depressive symptoms, risk behaviours, self-esteem, and social support differed in importance in the prediction of suicidal ideation based on rural-urban setting and gender. Results reflecting differences underscore the importance of examining such factors in mental health research. A “one size fits all” approach to youth mental health promotion and suicide prevention does not appear to be a prudent strategy. How to intervene: Youth engagement was explored as one possible means of intervention. In rural youth, personally meaningful engagement and engagement in a number of activities was directly inversely related to suicidal ideation. Regression analyses involving interaction analyses were carried out with youth engagement as a moderator for mental health indicators such as depressive symptoms, risk behaviours, self-esteem, and social support in the prediction of suicidal ideation. Through simple slope analyses, it was found that youth engagement significantly reduces the relationships between suicidal ideation and mental health indicators, particularly for males (p < .001). Therefore, youth engagement appears to be more universally beneficial for rural youth, given that rural dwelling appears to be a risk factor for suicidal ideation. Moreover, for male youth at risk for suicidal ideation, given depressive symptoms, risk behaviours, low self-esteem, and low perceived social support, youth engagement may be of particular benefit. With knowledge of who is at greatest risk for suicidal ideation, what factors to target, and a possible intervention road map, we can reach youth and foster resiliency before suicidal thoughts emerge.

Background: Recent analyses have described metabolomic markers for depression and suicidal ideation in non-pregnant adults. We examined the metabolomic profile of antepartum depression and suicidal ideation during mid-pregnancy, a time of high susceptibility to mood disorders. Methods: We collected fasting blood from 100 pregnant Peruvian women and profiled 307 plasma metabolites using liquid chromatography-mass spectrometry. We used the Patient Health Questionnaire 9 to define antepartum depression (score ≥ 10) and suicidal ideation (having thoughts that you would be better off dead, or of hurting yourself). Logistic regression was used to calculate odds ratios (ORs). Results: Three triacylglycerol metabolites (C48:5 triacylglycerol [OR = =1.89; 95% confidence interval (CI): 1.14–3.14], C50:6 triacylglycerol [OR = =1.88; 95%CI: 1.13–3.14], C46:4 triacylglycerol [OR = =1.89; 95%CI: 1.11–3.21]) were associated with higher odds of antepartum depression and 4 metabolites (betaine [OR = =0.56; 95%CI:0.33–0.95], citrulline [OR = =0.58; 95%CI: 0.34–0.98], C5 carnitine [OR = =0.59; 95%CI: 0.36–0.99], C5:1 carnitine [OR = =0.59; 95%CI: 0.35–1.00]) with lower odds of antepartum depression. Twenty-six metabolites, including 5-hydroxytryptophan (OR = =0.52; 95%CI: 0.30–0.92), phenylalanine (OR = =0.41; 95%CI: 0.19–0.91), and betaine (OR = =0.53; 95%CI: 0.28–0.99) were associated with lower odds of suicidal ideation. Limitations: Our cross-sectional study could not determine whether metabolites prospectively predict outcomes. No metabolites remained significant after multiple testing correction; these novel findings should be replicated in a larger sample. Conclusions: Antepartum suicidal ideation metabolomic markers are similar to markers of depression among non-pregnant adults, and distinct from markers of antepartum depression. Findings suggest that mood disorder in pregnancy shares metabolomic similarities to mood disorder at other times and may further understanding of these conditions’ pathophysiology. / Revisión por pares

The purpose of the current study was to investigate the relative importance of diagnostic and psychosocial factors in the prediction of adolescent suicidal ideation. Previous research has shown both sets of variables to be significantly related to suicidality but has failed to compare their relative efficacy in explaining suicidal ideation. It was hypothesized that diagnostic variables would afford better prediction of suicidal ideation than psychosocial variables, diagnostic variables would predict suicidal ideation above and beyond psychosocial variables, and psychosocial variables would predict suicidality after controlling for the effects of diagnostic variables. This study included valid diagnostic and psychosocial variables, employed independent diagnoses as opposed to diagnostic groupings, and utilized continuous measures of psychiatric symptomatology, in series of regression analyses to test these hypotheses. Results revealed that diagnostic variables, in particular, severity of major depressive disorder symptomatology, afforded the strongest prediction of suicidal ideation, even after controlling for psychosocial variables. The comorbid combination of mood disorder and generalized anxiety disorder was found to be the most strongly linked to suicidal ideation of all diagnostic combinations. However, social support added to the prediction of suicidal ideation above and beyond that offered by all diagnostic variables. Moreover, the interaction of social support and family environment predicted suicidality above and beyond severity of major depressive disorder symptomatology. It was concluded that optimal prediction of suicidality is likely obtained through the utilization of continuous measures of psychiatric symptomatology in suicide research. Moreover, suicide research and clinical practice should include examinations of both diagnostic and psychosocial variables to increase prediction and understanding of suicidal ideation in adolescents. / Ph. D.

Indiana University-Purdue University Indianapolis (IUPUI) / Using data from the 2007-2017 cycles of the national Youth Risk Behavior Survey (YRBS), this researcher aimed to understand how weapons carrying mediates the association between bullying and mental health outcomes. I dichotomized four bullying outcomes to create one new carried a weapon after bullied (CWB) (no/yes; e.g. did not carry a weapon post-bullying vs. did carry a weapon post-bullying) for each bullying type. Mental health outcomes included (all dichotomized, past 2 weeks, no/yes): felt sad or hopeless, seriously considered suicide, had a plan for suicide and attempted suicide. I used descriptive statistics and binary logistic regression adjusted for YRBS sampling methods and weighting (Stata 15.0). Initial results showed that weapons carrying has a complex relationship with mental health after bullying. One notable finding is that individuals who had been in a physical fight were the most likely to carry a weapon (N = 268), followed by those who had been threatened at school (N = 233). Additionally, more students who had been bullied at school (N = 185) carried a weapon than those who were victims of cyberbullying (N = 166). Another interesting result found that across all bullying types, males were 2 to 3 times more likely to carrying a weapon as a result of being bullied. In terms of mental health, being threatened at school was the most significant bullying type in relation to suicidal ideation.

No description available.

Evidence is mixed regarding an independent association between anxiety and suicidality. Beyond associations with demographic factors and depression, do anxiety disorders increase risk for suicidality in youth? Given that not all anxiety-disordered youth experience suicidal ideation, potential predictors of risk also require investigation. The present study examined (a) the independent relationship between anxiety and suicidal ideation and (b) comorbid depressive disorders, emotion dysregulation, and distress intolerance as predictors of risk for suicidal ideation in a sample of anxiety-disordered youth aged 7-17 (N = 86, M = 11.5). Youth and parents reported on suicidality, comorbid depressive disorders, emotion dysregulation, and distress intolerance. Distress tolerance was further measured by a computerized behavioral task. Results supported an independent relationship between anxiety symptomatology and youth-reported suicidal ideation, controlling for depressive symptoms. Youth self-report of emotion dysregulation and distress intolerance predicted higher levels of suicidal ideation in univariate analyses. In a multivariate analysis including all significant predictors, only anxiety symptomatology uniquely predicted suicidal ideation. Results are discussed in terms of implications for assessment and treatment in anxiety-disordered youth. Suggestions for future research investigating the relationship between anxiety and suicidal ideation in youth are offered. / Psychology

The three-step theory of suicide (3ST) proposes that suicidal ideation (SI) and behavior develops in the context of unbearable pain and hopelessness (Step 1), low social connection (Step 2) and acquired capability (Step 3 - not assessed in this study; Klonsky et al., 2016). Distress disclosure is one way a person may utilize their social network to mitigate feelings of distress and can be a critical measure of social connectedness. Building on efforts to diversify measurement of social connectedness in the 3ST, a sample of 549 college students (mean age = 19.27, SD = 1.28; 56.6% reporting history of SI) completed measures of physical and psychological pain (Patient Health Questionnaire – Revised; Unbearable Psychache Scale-3), hopelessness (State Hopelessness Scale; Beck Hopelessness Scale-4), social connectedness (Interpersonal Needs Questionnaire; Social Connectedness Scale – Revised; Distress Disclosure Index), and suicidal ideation (Depression Severity Index; Suicide Cognitions Scale – Shortened). Structural equation modeling was used to evaluate steps one and two of the 3ST and the utility of incorporating distress disclosure into this framework. In line with the 3ST, the structural model including pain, hopelessness, and social connectedness was supported and the direct effects of these variables on SI was significant (p < .05). In contrast to the 3ST, the interaction between pain and hopelessness did not predict SI (p = .385), nor was the moderating role of social connectedness supported (p = .133). Although distress disclosure was a significant indicator of social connectedness (p = .001), this variable did not contribute additional variance over other measures of connectedness. The results provide partial support for core features of the 3ST, however further research is needed to verify the theoretical assumptions of Step 2. Additionally, although disclosure is associated with SI, it may not be a critical measure of social connectedness when considered alongside traditional measures.

Adolescent suicide is a serious and growing problem among adolescents. Therefore, the goal of the current study was to try and identify predictors of suicidal ideation. The first objective was to examine whether the level of engagement in risky behavior predicts an increase in total suicidal ideation above and beyond other well-known risk factors (i.e., family functioning, gender, and problem-solving skills). The second objective was to investigate whether different types of risky behaviors (i.e., internalizing versus externalizing) predict different forms of suicidal ideation (i.e., passive versus active) above and beyond perceived family functioning, gender, and problem-solving skills. The pre-test archival data of 358 students who participated in a weekly problem-solving group were analyzed. Using four questionnaires, their perceived family functioning, knowledge of the problem-solving process, number of risk-taking behaviors, and level of suicidal ideation were assessed during the first and last sessions. Gender and perceived family functioning uniquely and consistently contributed to the variance in active, passive and total suicidal ideation scores. The active, passive and total suicidal ideation scores of adolescent males were consistently lower than adolescent females. When compared to adolescents who described having no relationship with their families, those adolescents who reported having a good or great relationship with their families consistently reported lower passive, active, and total suicidal ideation scores. Having an okay relationship produced mixed results. Total risky behavior scores significantly predicted adolescents’ total suicidal ideation scores above and beyond perceived family functioning and gender. In addition, internalizing behaviors, but not externalizing behaviors, predicted an increase in passive, active, and total suicidal ideation scores above and beyond perceived family functioning and gender. Based on these findings, current screening, prevention and treatment programs would benefit from adding questions designed to determine an adolescent’s engagement in internalizing behaviors and how they perceive their family relationships. This may help in identifying at-risk adolescents earlier so that they can receive the help and support they require.