BDNF methylation and mRNA expression in brain and blood of completed suicides in Slovenia

BACKGROUND Suicide is a major public health problem.Worldwide,around 800000 people die by suicide every year.Suicide is a multifactorial disorder,with numerous environmental and genetic risk factors involved.Among the candidate genes,changes in the BDNF locus at the gene,epigenetic,mRNA,and protein expression levels have been implicated in psychiatric disorders,including suicidal behavior and completed suicides.AIM To investigate changes in BDNF methylation and expression of four alternative BDNF transcripts for association with completed suicide.METHODS This case-control study included 42 unrelated male Caucasian subjects,where 20 were control subjects who died following acute cardiac arrest,and 22 were suicide victims who died by hanging.DNA and RNA were extracted from brain tissue(Brodmann area 9 and hippocampus)and from blood.DNA methylation and mRNA expression levels were determined by targeted bisulfite next-generation sequencing and reverse-transcription quantitative PCR.Statistical analysis was done by use of two-tailed Student’s t tests for two independent samples,and the Benjamini-Hochberg procedure was implemented for correction for multiple comparisons.RESULTS In DNA from brain tissue,there were no significant differences in BDNF methylation between the study groups.However,data showed significantly reduced DNA methylation of the BDNF region upstream of exon I in blood samples of suicide victims compared to the controls(5.67±0.57 vs 6.83±0.64,P_(corr)=0.01).In Brodmann area 9 of the brain of the suicide victims but not in their hippocampus,there was higher expression of BDNF transcript I-IX(NM_170731.4)compared to the controls(0.077±0.024 vs 0.05±0.013,P=0.042).In blood,expression analysis for the BDNF transcripts was not feasible due to extensive RNA degradation.CONCLUSION Despite the limitations of the study,the obtained data further support a role for BDNF in suicidality.However,it should be noted that suicidal behavior is a multifactorial disorder with numerous environmental and genetic risk factors involved.

Adolescent suicide risk factors and the integration of socialemotional skills in school-based prevention programs

Adolescents are considered one of the most vulnerable groups affected by suicide.Rapid changes in adolescents’physical and mental states,as well as in their lives,significantly and undeniably increase the risk of suicide.Psychological,social,family,individual,and environmental factors are important risk factors for suicidal behavior among teenagers and may contribute to suicide risk through various direct,indirect,or combined pathways.Social-emotional learning is considered a powerful intervention measure for addressing the crisis of adolescent suicide.When deliberately cultivated,fostered,and enhanced,selfawareness,self-management,social awareness,interpersonal skills,and responsible decision-making,as the five core competencies of social-emotional learning,can be used to effectively target various risk factors for adolescent suicide and provide necessary mental and interpersonal support.Among numerous suicide intervention methods,school-based interventions based on social-emotional competence have shown great potential in preventing and addressing suicide risk factors in adolescents.The characteristics of school-based interventions based on social-emotional competence,including their appropriateness,necessity,cost-effectiveness,comprehensiveness,and effectiveness,make these interventions an important means of addressing the crisis of adolescent suicide.To further determine the potential of school-based interventions based on social-emotional competence and better address the issue of adolescent suicide,additional financial support should be provided,the combination of socialemotional learning and other suicide prevention programs within schools should be fully leveraged,and cooperation between schools and families,society,and other environments should be maximized.These efforts should be considered future research directions.

Suicide risk in juvenile open angle glaucoma patients

AIM:To investigate the association between juvenile open angle glaucoma(JOAG)and mental health among Koreans.METHODS:This study used nationally representative data from the 8th Korea National Health and Nutrition Examination Survey(KNHANES)2021.Glaucoma diagnosis followed the International Society of Geographical and Epidemiological Ophthalmology criteria based on glaucomatous structural defects,visual field defects,corrected vision,and intraocular pressure.As outcomes,suicidal behaviors,psychiatric counseling,and depression were evaluated through mental health questionnaires.Odds ratios(ORs)with 95%confidence intervals(CIs)were estimated using logistic regression models,adjusting for covariates.RESULTS:Among 7090 participants,3446 met the inclusion criteria for analysis,and 88(2.6%)were diagnosed with open angle glaucoma(OAG).After adjusting for age,sex,and best-corrected visual acuity(VA),participants with OAG were revealed to have significantly higher odds of suicidal behaviors(i.e.,ideation,planning,or attempts)compared with those without OAG(OR:2.70;95%CI:1.12-6.54;P=0.028).This association remained significant after further adjustments for socioeconomic status,lifestyle factors,and presence of chronic conditions(P=0.031 and 0.035,respectively).However,there was no significant difference for the other two outcomes,psychiatric counseling and depression.An age-stratified analysis revealed a stronger association between OAG and suicidal behaviors in younger JOAG participants(<40y)than in older OAG participants(≥40y;OR:3.80 vs 2.22;95%CI:0.79-18.22 vs 0.56-8.80,respectively).CONCLUSION:OAG patients show a higher risk of suicidal behaviors than those without glaucoma particularly in JOAG patients.

Predicting Users’ Latent Suicidal Risk in Social Media: An Ensemble Model Based on Social Network Relationships

Suicide has become a critical concern,necessitating the development of effective preventative strategies.Social media platforms offer a valuable resource for identifying signs of suicidal ideation.Despite progress in detecting suicidal ideation on social media,accurately identifying individuals who express suicidal thoughts less openly or infrequently poses a significant challenge.To tackle this,we have developed a dataset focused on Chinese suicide narratives from Weibo’s Tree Hole feature and introduced an ensemble model named Text Convolutional Neural Network based on Social Network relationships(TCNN-SN).This model enhances predictive performance by leveraging social network relationship features and applying correction factors within a weighted linear fusion framework.It is specifically designed to identify key individuals who can help uncover hidden suicidal users and clusters.Our model,assessed using the bespoke dataset and benchmarked against alternative classification approaches,demonstrates superior accuracy,F1-score and AUC metrics,achieving 88.57%,88.75%and 94.25%,respectively,outperforming traditional TextCNN models by 12.18%,10.84%and 10.85%.We assert that our methodology offers a significant advancement in the predictive identification of individuals at risk,thereby contributing to the prevention and reduction of suicide incidences.

COVID-19 pandemic amplified mortality rates among adolescents with bipolar disorder through family-related factors

BACKGROUND Recently,a growing number of adolescents have been afflicted with mental disorders,with annual morbidity rates on the rise.This trend has been exacerbated by the global coronavirus disease 2019(COVID-19)pandemic,leading to a surge in suicide and self-harm rates among this demographic.AIM To investigate the impact of the COVID-19 pandemic on adolescent bipolar disorder(BD),along with the underlying factors contributing to heightened rates of suicide and self-harm among adolescents.METHODS A comprehensive statistical analysis was conducted utilizing clinical interviews and self-reports obtained from patients or their guardians.Diagnostic criteria for BDs were based on the Diagnostic and statistical manual of mental disorders,international classification of diseases-11,and the National institute of mental health research domain criteria.Statistical analyses were performed using SPSS 26.0 software,with significance set at P<0.05.RESULTS A cohort of 171 adolescents diagnosed with BD between January 1,2018,and December 31,2022,was included in the analysis.The gender distribution was 2.8:1(female to male),with ages ranging from 11 to 18 years old.Major factors contributing to adolescent BDs included familial influences,academic stress,genetic predisposition and exposure to school-related violence.Notably,a significant increase in suicide attempts and self-harm incidents was observed among adolescents with BD during the COVID-19 pandemic.Statistical analysis indicated that the pandemic exacerbated familial discord and heightened academic stress,thereby amplifying the prevalence of suicidal behavior and self-harm among adolescents.CONCLUSION The COVID-19 pandemic has exacerbated familial tensions and intensified the incidence of suicide and self-harm among adolescents diagnosed with BD.This study underscores the urgent need for societal,familial and educational support systems to prioritize the well-being of adolescents and offers valuable insights and guidelines for the prevention,diagnosis and treatment of adolescent BDs.

Analysis of risk factors of suicidal ideation in adolescent patients with depression and construction of prediction model

BACKGROUND Major depressive disorder is a common mental illness among adolescents and is the largest disease burden in this age group.Most adolescent patients with depression have suicidal ideation(SI);however,few studies have focused on the factors related to SI,and effective predictive models are lacking.AIM To construct a risk prediction model for SI in adolescent depression and provide a reference assessment tool for prevention.METHODS The data of 150 adolescent patients with depression at the First People's Hospital of Lianyungang from June 2020 to December 2022 were retrospectively analyzed.Based on whether or not they had SI,they were divided into a SI group(n=91)and a non-SI group(n=59).The general data and laboratory indices of the two groups were compared.Logistic regression was used to analyze the factors influencing SI in adolescent patients with depression,a nomogram prediction model was constructed based on the analysis results,and internal evaluation was performed.Receiver operating characteristic and calibration curves were used to evaluate the model’s efficacy,and the clinical application value was evaluated using decision curve analysis(DCA).RESULTS There were differences in trauma history,triggers,serum ferritin levels(SF),highsensitivity C-reactive protein levels(hs-CRP),and high-density lipoprotein(HDLC)levels between the two groups(P<0.05).Logistic regression analysis showed that trauma history,predisposing factors,SF,hs-CRP,and HDL-C were factors influencing SI in adolescent patients with depression.The area under the curve of the nomogram prediction model was 0.831(95%CI:0.763–0.899),sensitivity was 0.912,and specificity was 0.678.The higher net benefit of the DCA and the average absolute error of the calibration curve were 0.043,indicating that the model had a good fit.CONCLUSION The nomogram prediction model based on trauma history,triggers,ferritin,serum hs-CRP,and HDL-C levels can effectively predict the risk of SI in adolescent patients with depression.

Depression and Suicidal Risk in HIV-Infected Adults at Brazzaville University Hospital: Prevalence and Associated Factors

Introduction: Highly active antiretroviral tritherapies have improved the quality of life of people living with HIV (PVVIH) and extended their life expectancy. However, the nervous system is faced with a neurotropic virus that evolves chronically, sometimes creating neurological disorders directly or indirectly linked to stigmatization or therapeutic effects. Objective: to determine the prevalence of depression associated with suicidal risk (SR) and identify associated factors. Patients and method: This was a prospective descriptive and analytical study from January 1 to November 30, 2022, including all HIV-positive patients receiving or not receiving antiretroviral therapy. The study took place in the infectious diseases department of Brazzaville University Hospital. This department has an inpatient capacity of 36 beds, and an outpatient capacity of 25 patients per day, three times a week. This is the largest center for PVVIH in Brazzaville. The Patient Heath Questionnaire 9 (PHQ-9) was used to assess the degree of depression and suicidal risk. Therapeutic adherence was assessed using the Morisky questionnaire. Data were analyzed using SPSS version 23 software. Qualitative variables were expressed as numbers and percentages, and quantitative variables as means and standard deviations. Statistical tests were used according to their applicability criteria. For all tests, the significance threshold was set at 0.05. Results: A total of 150 patients were consulted, constituting the sample size. The prevalence of depression and suicidal risk was 32%. These patients had an average age of 42.83 ± 10.24 years, were female (n = 101;67.3%), Christian (n = 97;64%), single (n = 68;45.3%). Stigmatization (n = 75;50%) was the reason for attempted suicide. HIV was perceived as treatable (n = 103;68.7%), unlucky (n = 62;41.3%). Patients were WHO stage 1 (n = 105;70%). RS was present in 47 cases (31.3%). Factors associated with depression and suicidal risk were age (p = 0.000), residence (p = 0.028), suicide attempt (p = 0.000), desire to procreate (p = 0.000) and ARV (antiretrovirals) side effects (p Conclusion: The prevalence of depression and suicidal risk was high, in line with stigma and socio-economic conditions. The associated factors were in line with those identified in the literature. Mental health needs to be integrated into the overall care of people living with HIV.

A Retrospective Analysis of Intoxicated Patients Admitted to the Intensive Care Unit: A Single-Institution Assessment in the Post-Pandemic Period

Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the Intensive Care Unit (ICU). Material and Methods: An observational retrospective study was conducted on intoxicated patients who admitted to ICU between January 2022 and January 2024. Data were collected from the patients medical records. The demographic characteristics, causes of intoxications, clinical parameters, the mean stay in the ICU, treatment modalities and prognosis were recorded. Results: A total of 2875 critically ill patients were admitted during the study period, and 109 (3.79%) of them were acute intoxications. Their mean of ages was 38.09 ± 12.29. The female-to-male ratio was 1.37/1. Drugs were found to be the primary cause (62.39%) of intoxications, and analgesics, antidepressants, and antibiotics were the most frequent agents. Suicidal attempts were present in 66 patients, most of them were female (62.13%) and between 17 - 24 years (40.91%). The other common causes of intoxications were carbon monoxide (CO) (22.02%), methyl/ethyl alcohol (8.26%) and mushroom (5.50%). The mean stay in the ICU was 2.69 ± 0.89 days. Mechanical ventilation was applied to 10 of our patients. Renal replacement therapy was required in 6 patients. Despite all treatments, 6 of our patients died, and we found the mortality rate to be 5.50%. Conclusion: Intoxications were more frequent in young female patients and drugs were the most common cause with suicidal intent. Unfortunately, CO poisoning continues to be a very important problem in our city. These findings provided significant information about the characteristics of intoxications in Karabuk.

Suicide Ideation and Its Associated Factors among Men in Selected Compounds of Lusaka, Zambia

Background: Globally, it is estimated that more than 800,000 individuals die by suicide each year, making suicide one of the biggest causes of death worldwide. Additionally, suicide kills far more males than women, more so in developing regions that are characterized by economic distress due to low income. Although the number of suicide cases has been seen to increase from 2013 to date, limited studies provide information on the factors influencing the trend. Therefore, this study aimed at investigating the prevalence of suicidal ideation and factors associated with suicide in males in selected compounds of Lusaka. Methods: The study used an analytical quantitative cross- sectional study design that involved 367 men in Mtendere and Kaunda Square townships in Lusaka district, Zambia. A structured questionnaire was used to collect data from participants, which was analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. The Chi-square, Fisher’s exact test and Wilcoxon rank sum tests were used to test relationships among variables at a five percent level of significance. Ethical approval and clearance was obtained from the National Health Research Authority. Results: Participants had a median age of 29 years (IQR, 27 - 32 years), 216 (58.9%) were single and 278 (75.8%) attained tertiary education. Under a quarter, 75 (20.4%) reported suicide ideations, and 97 (26.4%) reported low social support. For most participants, 347 (94.7%) experienced at least one stressful life event, and 359 (97.8%) experienced severe levels of stress. Under half, 170 (46.3%) were alcohol dependent, while 54 (14.7%) used alcohol harmfully. Suicide ideation was significantly associated with marital status (p Conclusion: Suicide ideation is relatively high among men in Mtendere and Kaunda Square townships, mainly influenced by marital status, education level, social support, stressful events alcohol abuse. Efforts must be channeled towards suicide awareness campaigns, and establishment of supportive environments in health facilities which can make it easy for men to open up about their struggles.

Suicidal Behaviours in Sickle Cell Patients at the Douala Sickle Cell Care Centre in Cameroon

Introduction: Sickle cell anaemia is a hereditary disease that combines physical and psychological manifestations, including suicidal tendencies. So far, to our knowledge, no study has been conducted on suicidal behaviours among people with sickle cell disease in Cameroon. This is what justifies our study on the prevalence and factors related to suicidal behaviors in our study population. Methods: We conducted a cross-sectional, analytical study of 171 sickle cell patients aged from 12 years upwards who came to the sickle cell disease care service of the Laquintinie Hospital in Douala, over a period of 6 months, that is, from 1 January to 31 June 2022. Data were collected using a structured questionnaire with questions on suicidal behaviours based on the “MINI” (Mini International Neuropsychiatric Interview). The data were processed using the SPSS 26.0 software. The related factors were studied in both a bivariate and multivariate analysis. Results: Female sickle cell patients accounted for 60.2% of the sample. The mean age was 23.36 ± 8.42 years. Suicidal ideation was prevalent in 56% of cases and 13% attempted suicide. The factors most associated with suicidal ideation were: primary level of education (OR = 0.08 (0.09 - 0.79);p = 0.03), feeling unworthy of life (OR = 0.40 (0.08 - 1.96);p = 0.02), not often being considered by those around them (OR = 2.97 (1.26 - 6.99);p = 0.01), lack of family support (OR = 0.34 (0.15 - 0.77);p = 0.01). Meanwhile, the factors associated with suicide attempts were: the fact of being rarely exposed to suicide-related media (OR = 4.17 (1.40 - 71.80);p = 0.03), and a constant feeling of sadness when returning home (OR = 18.02 (1.59 - 20.55);p = 0.01). Conclusion: More than half of sickle cell patients had had suicidal thoughts and 1/6 had made at least one suicide attempt, women and young adults being the most concerned. It is therefore necessary to ensure optimum psychological care for patients with sickle cell disease.

Chemical components of ambient particulate air pollution affecting suicides in Thailand

This research studied correlation between suicide risks and chemical components of particulate matter in Thailand.It employed satellite data on atmospheric particulate matter.Analysis for correlation between data on chemical components of particulate matterda type of accumulated pollution in Thailand from 2010 to 2017dand suicidal incidents in 2018.The methodologies consisted of Bayesian hierarchical spatiotemporal model and the Poisson log-linear model,which referred to the NASA database;aerosol diagnostics model,Modern-Era Retrospective Analysis for Research and Applications,Version 2(MERRA-2);and database from the Bureau of Policy and Strategy Ministry of Public Health,Thailand.A total of 4,756 patients selected for this study accounted for annual suicide rate of 7.16 per 100,000 population.Suicides in Thailand are related to chemical components of particulate matter.This research thus found that every 1 mg/m^(3)increase of dust-PM2.5,only PM2.5 was related to the risks of suicide(which increased for approximately 63.5%).Black carbon,Organic carbon,and sulfate,however,had no statistically significant effects.Volume of atmospheric accumulated dust-PM2.5 correlated to increase in suicide risks,with statistical significance.

Euthanasia controversy in China:do we have the right to die?

This research examines the contentious issue of euthanasia and physician-assisted suicide in the context of China's unique conditions.Historically,the debate over euthanasia has been influenced by moral philosophy and ethics,and euthanasia is illegal in China at present.The research explores the difficulty in making euthanasia legalized across five key dimensions:financial,medical,social,legal,and psychological factors.We conclude that while there is a desire among some terminally ill patients for euthanasia,the current situation in China makes it unsuitable for legalization.The profound question of one's right to die remains a significant moral and judicial challenge,indicating the need for continued dialogue and nuanced understanding of this complex issue.

Analysis of 158 Cases of Suicides.

The domestic data showed that, among the causes of abnormal deaths, suicide ranked at the top of the causal factors in recent years. This hospital had rescued 158 cases of suicides from 1983 to 1992. Among them, females were much

Over 1,000 Suicides Daily in East Asia, Australia

世界卫生组织认为东亚和西太平洋地区每日有1000多人自杀,且这个数字还在上升！文章的开头和结尾均对这种现象作了分析:economicinsecurity,breakdowns of family ties and other factors/Disasters,armed conflictand violence,displacement(移置),urbanization,migration(移民),unemployment, work stress, unwanted pregnancies, family disruption and socialisolation……年轻人自杀的原因是:rigid school entrance examinations(是否可译“苛刻的入学考试”?)】

Characteristics of Suicides Caused by Drug Overdose in the State of Maryland

Suicidal drug overdose is a major public health issue.In the United States,every year more than 33,000 people commit suicides.Our study focused on the characteristics of suicide victims in the state of Maryland.Material and methods:This study was a retrospective review of autopsy cases of all suicide deaths caused by drug(s)or drug(s)with alcohol intoxication investigated by the OCME in Maryland over a 7-year period from January 2004 to December 2011.All deaths investigated by the OCME that require autopsy examination are subject to comprehensive toxicology testing for drugs and alcohol.The screen tests were performed using gas chromatography(GC)and radioimmunoassay techniques.All detected drugs and/or metabolites were confirmed using GC-mass spectrometry(GC-MS).Results:From 2004 to 2011,434 deaths were certified as suicide.Of the 434 suicidal overdose deaths,84%were white,11%were African-American,and about 5%were either Hispanic or Asian.The male and female ratio was almost equal.Their ages ranged 15-82 years.Of the 434 suicidal drug overdose deaths,277 victims(63.8%)consumed a single drug type and 157(36.2%)consumed more than one type of drug.Of the 277 single-drug overdose cases,71.1%suicides were due to prescription drugs,23.5%due to over-the-counter drugs,and 5.4%due to street/recreational drugs.Among single-type prescription drugs,analgesic(N=76),antidepressant(N=45),and neuroleptic(N=35)classes were the three leading type of drugs used in suicidal deaths.Oxycodone,morphine,quetiapine,and amitriptyline were the most common prescription drugs in suicidal overdose.Diphenhydramine was the leading over-the-counter drug.Of the 157 victims who consumed more than one drug,combined prescription drugs were present in 54.1%,mixed prescription and overthe-counter drugs in 29.3%,and prescription drugs/over-the-counter drugs and street drugs in 16.6%of cases.Of the multiple-drug overdose suicides,66.2%cases involved antidepressants.Discussion:Suicide is found in every age,racial,and ethnic group.In the USA,poisoning is thethird-leading method of suicide,following firearm injuries and hanging/strangulation.Our study indicates that prescription drugs,such as those in the opioid analgesic,neuroleptic,and antidepressant class(e.g.,oxycodone,morphine,quetiapine,amitriptyline,doxepin,and citalopram),are of special concern in the context of suicidal overdose deaths in the state of Maryland.Therefore,addressing the problems of intentional drug overdose in our society is worthy of public attention.

Epigenetics in psychiatry:Beyond DNA methylation

The global burden of psychopathologies appears to be underestimated,since the global psychiatric disorder burden is exceeding other medical burdens.To be able to address this problem more effectively,we need to better understand the etiology of psychiatric disorders.One of the hallmarks of psychiatric disorders appears to be epigenetic dysregulation.While some epigenetic modifications(such as DNA methylation)are well known and studied,the roles of others have been investigated much less.DNA hydroxymethylation is a rarely studied epigenetic modification,which as well as being an intermediate stage in the DNA demethylation cycle is also an independent steady cell state involved in neurodevelopment and plasticity.In contrast to DNA methylation,DNA hydroxymethylation appears to be related to an increase in gene expression and subsequent protein expression.Although no particular gene or genetic locus can be at this point linked to changes in DNA hydroxymethylation in psychiatric disorders,the epigenetic marks present good potential for biomarker identification because the epigenetic landscape is a result of the interplay between genes and environment,which both influence the development of psychiatric disorders,and because hydoxymethylation changes are particularly enriched in the brain and in synapse-related genes.

Lethal means and suicide prevention among military veterans

Dear Editor,Suicide amongst the military veteran population is a significant publichealthproblemintheUnitedStates.TheNational VeteranSuicidePreventionAnnualReportrevealedthat6261 died by suicide in 2019[1]. The lingering effects of the coronavirus disease 2019 (COVID-19) pandemic may account for an increase in veteran suicide rates[1].

Security breach:peripheral nerves provide unrestricted access for toxin delivery into the central nervous system

We explore the hypothesis that a potential explanation for the initiation of motor neuron disease is an unappreciated vulnerability in central nervous system defense,the direct delivery of neurotoxins into motor neurons via peripheral nerve retrograde transport.This further suggests a mechanism for focal initiation of neuro-degenerative diseases in general,with subsequent spread by network degeneration as suggested by the Frost-Diamond hypothesis.We propose this vulnerability may be a byproduct of vertebrate evolution in a benign aquatic environment,where external surfaces were not exposed to concentrated neurotoxins.

Suicide in Digestive System Cancers: A Scoping Review

Digestive system cancers are important causes of morbidity and mortality worldwide.Cancer patients are more likely to commit suicide.The objective of this scoping review is to provide a comprehensive and updated summary of the existing literature on suicide among patients with digestive system cancers to identify the incidence and risk factors relevant to suicide in these populations.The PRISMA-Scr(Preferred Reporting Items for Systematic reviews and Meta-Analyses extension protocol for scoping reviews)protocol was used.The review was based on relevant articles published prior to January 2022 in databases of Web of Science and PubMed.The authors identified 21 records that met the criteria for inclusion.Among the 21 articles,18(n=85.7%)reported suicide risk factors,21(n=100%)evaluated the incidence of suicide and 16(n=76.2%)involved the variation in suicide rates.Only one study comprehensively reported that the suicide rate for this population was 32.8 per 100,000 years and the standardized mortality ratio(SMR)was 1.91.Most suicides occurred in patients with pancreatic,esophageal,and gastric cancers.The factors associated with suicide in digestive system cancers included male gender,older age,the white race,single status,advanced stage of disease,and cancer metastasis.The most critical time for suicide was in the early post-diagnostic period.It is indispensable to identify suicide in these cancer patients,especially those with high-risk factors.In the future,more prospective research may be needed to provide more reliable support and care to prevent suicide.

Mental health implications of suicide rates in South Africa

Mental health challenges are a severe issue that could lead to suicide if not properly addressed.South Africa has a significant burden of mental health issues,which contributes to the soaring rate of suicide.Adequate mental health-care provision could reduce the high suicide rate in South Africa.Since the apartheid regime,the country has made a series of efforts to improve mental health.This study aimed to review and examine available literature on mental health and suicide issues in South Africa and demonstrate the policy implications.This study adopted a narrative review approach.Electronic databases(PubMed,Scilit,Google Scholar and Semantic Scholar)were used to identify published articles in the English language with crucial search terms that included mental health,South African mental health policy,South Africa,suicide and policy.Literature suggests that at the provincial level,there are no adequate mental health policies,and the implementation of the country’s mental health policy is faced with many challenges,such as a shortage of professionals and finances.The review also showed that task sharing and counselling have been pilot-tested and shown to be effective methods for the prevention of mental illness and promotion of positive mental health.This study concludes that the mental health treatment gap still exists in South Africa,and this needs to be tackled using effective,multi-level counselling interventions and policy initiatives.Adequate mental health-care provision and effective implementation of mental health policy could reduce the high rate of suicide in South Africa.