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.

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].

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.

Suicide Attempts in a General Hospital: A Case-Control

Objective: This study aims is to conduct a comparative analysis of the clinical and sociodemographic profiles of individuals referred to Consultation-Liaison Psychiatry (CLP) at a tertiary general hospital, specifically focusing on those seeking assistance due to suicide attempts (TS) versus CLP requests for other reasons (non-TS) between the years 2010 and 2020. Additionally, we aim to assess factors associated with suicide attempts. Method: This retrospective controlled study involves a thorough examination of medical records encompassing 3913 patients who received CLP services at the Hospital de Base (HB) and the Children and Maternity Hospital (HCM) of São José do Rio Preto Medical School Foundation (Funfarme) from June 2010 to June 2020. The patient cohort is categorized into two groups: those with requests for SA (n = 677) and those with requests for other reasons. Results: In the SA group, as opposed to the non SA group, statistically significant differences were observed for gender (predominantly female), employment status (employed), marital status (single), and age (younger). Notably, a higher prevalence of psychiatric antecedents (88.7%, n = 555 vs. 73.6% n = 2018) was found in the SA group, indicating a significant association. The frequency of SA requests remained stable over the years. Among the SA group, mood disorders were the most prevalent (39%, n = 372), followed by disorders related to substance use (21.2%, n = 202), and personality disorders (16%, n = 152). A history of previous suicide attempts emerged as a crucial factor for the recurrence of SA (p-value ≤ 0.001). Exogenous intoxication emerged as the most frequently employed method in attempts (79.6%, n = 539), particularly prevalent among patients diagnosed with mood disorders (41%, n = 314). A significant association was observed between the method of attempt and the nosological psychiatric diagnosis (χ2 = 42.277;p ≤ 0.001). Regarding outcomes, the majority of patients were referred for outpatient follow-up (23%, n = 336) in specialized mental health services or at the Primary Healthcare Unit, highlighting the general hospital’s pivotal role in integrating patients into the broader healthcare network. Conclusion: Variables such as gender (female), age group (young adults), and psychiatric history exhibited stronger associations with suicide attempts compared to the group assisted by CLP for other reasons. Furthermore, a noteworthy correlation between the method employed and the psychiatric diagnosis was identified.

The Utility of Artificial Intelligence for Mood Analysis,Depression Detection,and Suicide Risk Management

Mood disorders are often an indication or a sign of depression,and individuals suffering from mood swings may face higher probability and increased suicidal tendencies.Depression-also called“clinical depression”or a“depressive disorder”-is a mood disorder that adversely impacts how an individual feels,thinks,and handles daily activities,such as sleeping,eating,or working.To be diagnosed with depression,symptoms must be present most of the time,nearly every day for at least minimum of 2 to 3 weeks.Feeling sad or having low emotional energy may be common among people.For most,however,these feelings are transitory and can be managed by changing daily life routines.But for some,prolonged mood disorders can lead to depression and foster suicidal tendencies.Suicide is a major public health concern.Over 47,000 people died by suicide in the United States in 2017.It is the 10th leading cause of death overall according to NIMH(National Institute of Mental Health).Suicide is complicated and tragic,but it is often preventable.Identifying the warning signs for suicide and how to get help can be a major mitigating factor.In this short communication,we are reviewing the promise and limitations of AI(artificial intelligence)with its integrated tools such as ML(machine learning)and DL(deep learning)for mood analysis as a means for detecting early signs of depression and increased suicidal tendencies for possible suicide risk management.

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.

Multidimensional Approach to Suicide Prevention in Jails and Prisons: The Best Defense against Liability Lawsuits

Inmates in jails and prisons are a high-risk group for suicide. Often, legal claims of medical negligence and §1983 based on deliberate indifference by the correctional officials follow. Unique stable and dynamic factors and circumstances and their interaction explain most suicides. A systematic suicide screening using a well-designed suicide screening questionnaire that captures known risk factors will identify most inmates at risk if adequately used. Identification and subsequent mental health assessment set the stage for preventive intervention, monitoring, and treatment of the inmates. A multidimensional suicide prevention program saves not only lives but also the best defense against a liability lawsuit.

Understanding the Unique Characteristics of Suicide in China: National Psychological Autopsy Study

Objective To compare the characteristics of suicides in the four main demographic groups： urban males, urban females, rural males and rural females in order to help clarify the demographic pattern of suicides in China. Methods A detailed psychological autopsy survey instrument was independently administered to 895 suicide victims in family members and close associates from 23 geographically representative locations from around the country. Results Pesticide ingestion accounted for 58% （519） of all suicides and 61% （3181519） of deaths were due to unsuccessful medical resuscitation. A substantial proportion （37%） of suicide victims did not have a mental illness. Among the 563 victims with mental illness, only 13% （76/563） received psychiatric treatment. Compared to other demographic groups, young rural females who died from suicide had the highest rate of pesticide ingestion （79%）, the lowest prevalence of mental illness （39%）, and the highest acute stress from precipitating life events just prior to the suicide. Contusion Many suicides in China are impulsive acts of deliberate self-harm following acute interpersonal crises. Prevention of suicides in China must focus on improving awareness of psychological problems, improving mental health services, providing alternative social support networks for managing acute interpersonal conflicts, limiting access to pesticides, and improving the resuscitation skills of primary care providers.

Prevalence and associated factors of suicide among hospitalized schizophrenic patients

BACKGROUND Previous studies found several factors associated with suicide in schizophrenic patients,such as age,sex,education level,history of suicide attempts,psychotic symptoms,social factors,and substance abuse.However,there might be some additional factors that were not considered in previous studies but may be correlated with a greater likelihood of suicide attempts,such as medication and treatment.AIM To investigate the prevalence of suicide attempts and identify the risk of suicidality in hospitalized schizophrenia patients.METHODS This is a cross-sectional study of schizophrenic patients admitted to a psychiatric hospital who were 18 years of age or more.The outcomes and possible suicide risk factors in these patients were collated.The current suicide risk was evaluated using the mini-international neuropsychiatric interview module for suicidality and categorized as none(0 points),mild(1-8 points),moderate(9-16 points),or severe(17 or more points).This study used ordinal logistic regression to assess the association of potential risk factors with the current suicide risk in schizophrenic patients.RESULTS Of 228 hospitalized schizophrenia patients,214(93.9%)were included in this study.The majority(79.0%)of patients were males.Females appeared to have a slightly higher suicidality risk than males,with borderline significance.With regard to the current suicide risk assessed with the mini-international neuropsychiatric interview,172(80.4%)schizophrenic patients scored zero,20(9.4%)had a mild risk,8(3.7%)had a moderate risk,and 14(6.5%)had a severe risk.The total prevalence of current suicide risk in these schizophrenic patients was 19.6%.Based on multivariable ordinal logistic regression analysis with backward elimination,it was found that younger age,a current major depressive episode,receiving fluoxetine or lithium carbonate in the previous month,or a relatively higher Charlson comorbidity index score were all significantly and independently associated with a higher level of suicide risk.CONCLUSION The prevalence rate of suicide attempts in schizophrenia is high.Considering risk factors in routine clinical assessments,environmental manipulations and adequate treatment might prevent or decrease suicide in these patients.

Mental Health, Religion and Suicide

Suicide is one of the most common yet serious concerns, and a worldwide subject that individuals have debated from the past to the present. Suicidal ideation affects and disrupts the functionality of a human being regardless of age, gender, ethnicity, or even religion. This article aims to discuss suicide in general and from an Islamic perspective in specific, as research has shown that an Islamically oriented approach and intervention works better with the Muslim population in general. The paper also aims to have a broader view of how Islam categorized suicide classically and its modern implications, which also lets us explore the similarities, and differences between the Islamic perspective and different religions about suicide and related mental health concerns. A collection of both classic and modern sources was used to extract information and provide a scope of definitions to clarify suicide and religiosity concerning the teachings and opinion of Islam about the meaning of life, afterlife, and soul. It was found that the Muslim population showed a lower rate of suicide in comparison to individuals from other religions, and religious individuals showed faster recovery from suicidal ideation. Yet, Muslims are not immune to mental health conditions that would result in suicide. Therefore, further studies and research need to be conducted to understand the huge stigma around Muslim about mental health and suicide in the Muslim communities, to compare the effectiveness among the religious and the non-religious Muslims, and lastly to fill the gap as to why the Muslim population tends to be hesitant in seeking help regarding their psychological problems.

Trends in Suicide by Poisoning in China 2000-2006: Age, Gender, Method, and Geography

Objective This study analyzed patterns of suicide and suicide attempts by poisoning as reported through a national poison control system for the purpose of improving intervention and prevention. Methods During the period of 2000 to 2006, 6440 cases of poisoning suicide were reported to the telephone consultation service system of The National Center for Poisoning Control （Chinese Center for Disease Control and Prevention）. Among these records, 4728 cases had completed data for this analysis in terms of age, sex, trend of time and location, and type of poisons. Results There were 60.6% female cases with the age from 10 to 90 years old. The age of cases from 20 to 39 years accounted for 54.5% of all age groups. Both the numbers and percentage in record related to poisoning consultation of oral poisoning suicide showed an increasing tendency during the 7 years. In particular, there was a drastic increase from 2004 to 2006. In addition, the high frequency of cases occurred from May to October. Hebei, Shandong, Henan, and Anhui Provinces had the highest number of cases. Pesticide poisonings were the most common method in these cases of consultation for suicide and suicide attempts. Conclusion This study describes epidemiological characteristics in the oral poisoning suicide cases and provides scientific basis for suicide prevention interventions.

Inter-relationships between isotretinoin treatment and psychiatric disorders: Depression, bipolar disorder, anxiety, psychosis and suicide risks

Isotretinoin(Accutane) is a treatment for severe acne that is resistant to other forms of treatment, including antibiotics and topical treatments. The prescription of this drug has been controversial ever since its initial marketing in 1982. It is the only non-psychotropic drug in the Food and Drug Administration top 10 drugs found to be associated with depression. Recently, Bremner et al published an extensive review(until 2010) of the evidence for the association of retinoic acid(RA) with depression and suicide. Some patients who are admitted in psychiatric hospitals report a history of present or past treatment with isotretinoin. Then, the imputability of the molecule in the occurrence of disorders represents necessarily an important question for both professionals and their patients. This paper aims to specify the links between the drug and specific psychiatric disorders. A review of the literature related to isotretinoin, RA, vitamin A, depression, suicide, anxiety, bipolar disorder, psychosis, schizophrenia was performed. Many studies demonstrated an increased risk of depression, attempted suicide and suicide following isotretinoin treatment. However, isotretinoin may have an antidepressant impact, according to some dermatological papers. They consider treating acne with this efficient treatment could improve selfimage and make the patient feel better. Several studies showed that patients with bipolar disorder had an increased risk for a clinical exacerbation of symptoms undergoing treatment with isotretinoin. A few studies also seem to suggest a possible link between isotretinoin and psychosis. Nonetheless, studies point out a link between retinoid dysregulation and schizophrenia through modulation of dopamine receptors. From this review, we propose guidelines for isotretinoin prescription to healthcare professionals.

Evaluation of miR-122-regulated suicide gene therapy for hepatocellular carcinoma in an orthotopic mouse model

Objective： Intratumoral administration of adenoviral vector encoding herpes simplex virus （HSV） thymidine kinase （TK） gene （Ad-TK） followed by systemic ganciclovir （GCV） is an effective approach in treating experimental hepatocellular carcinoma （HCC）. However, hepatotoxicity due to unwanted vector spread and suicide gene expression limited the application of this therapy, miR-122 is an abundant, liver-specific microRNA whose expression is decreased in human primary HCC and HCC-derived cell lines. These different expression profiles provide an opportunity to induce tumor-specific gene expression by miR-122 regulation. Methods： By inserting miR-122 target sequences （miR-122T） in the 3＇ untranslated region （UTR） ofTK gene, we constructed adenovirus （Ad） vectors expressing miR-122-regulated TK （Ad-TK-122T） and report genes. After intratumoral administration of Ad vectors into an orthotopic miR-122-deficient HCC mouse model, we observed the miR-122-regulated transgene expression and assessed the antitumor activity and safety of Ad-TK-122T. Results： Insertion of miR-122T specifically down-regulated transgene expression in vitro and selectively protected the miR-122-positive cells from killing by TK/GCV treatment. Insertion of miR-122T led to significant reduction of tansgene expression in the liver without inhibition of its expression in tumors in vivo, resulting in an 11-fold improvement of tumor-specific transgene expression. Intratumoral injection of Ad vectors mediated TK/GCV system led to a vector dosage-dependent regression of tumor. The insertion of miR-122T does not influence the antitumor effects of suicide gene therapy. Whereas mice administrated with Ad-TK showed severe lethal hepatotoxicity at the effective therapeutic dose, no liver damage was found in Ad-TK-122T group. Conclusions： miR-122-regulated TK expression achieved effective anti-tumor effects and increased the safety of intratumoral delivery of adenovirus-mediated TK/GCV gene therapy for miR-122-deficient HCC.

A qualitative study on nurses'reactions to inpatient suicide in a general hospital

Aims:To explore the impact of inpatient suicides on nurses working in front-line,the patterns of regulation and their needs for support.Methods:Data were collected through purposive sampling by conducting semi-structured and individual in-depth interviews in a tertiary referral hospital in China.Colaizzi's sevenstep phenomenological method was simultaneously used by two interviewers.Results:Reactions to inpatient suicides revealed three central themes:(1)inpatients were highly likely to commit suicide,(2)inpatient suicide was difficult to prevent,and(3)nurses lacked the necessary suicide prevention skills.Psychological responses mainly included shock and panic,self-accusation or guilt,sense of fear,and frustration.The impacts on practice were stress,excessive vigilance,and burnout.Avoidance and sharing of feelings played key roles in the regulation patterns of nurses.Conclusions:Nurses who experienced inpatient suicide became stressed.Effective interventions must be implemented to improve the coping mechanisms of nurses against the negative consequences of inpatient suicide.The findings of this study will allow administrators to gain insight into the impacts of inpatient suicides on nurses in general hospitals.Such information can be used to develop effective strategies and provide individual support and ongoing education.Consequently,nurses will acquire suicide prevention skills and help patients achieve swift recovery.

Suicide transport blockade of motor neuron survival generates a focal graded injury and functional deficit

We describe a pre-clinical spinal cord motor neuron injury model that is minimal invasive, reproducible, focal and easily applied to small rodents.Retrograde axonal transport of a pro-apoptotic phosphatidylinosotol 3'-kinase inhibitor, wortmannin, via the sciatic nerve results in loss of ipsilateral lumbar motor neurons proportional to the level of drug administered.Motor neuron loss was detected by choline acetyltransferase(ChAT) immunostaining and with a transgenic thy1-eGFP marker.The short half-life of wortmannin generates minimal wound spread, and wortmannin does not affect axon transport, as determined by co-injection of a pseudorabies virus tracer.Using quantitative transcript analysis, we found that ChAT transcripts significantly decreased at 14 days post-delivery of 1 μg wortmannin, relative to sham controls, and remained low after 90 days.Smaller effects were observed with 200 ng and 100 ng wortmannin.Wortmannin also generated a transient and significant increase in astrocyte Gfap transcripts after 14 days with a return to control levels at 90 days.Treated mice had hind limb spasticity and a forced motor function defect that was quantified using a water exit test.Controls rapidly exit a shallow water tray, and wortmannin treated animals were up to 12-fold slower, a phenotype that persisted for at least 3 months.Thus the focal delivery of wortmannin to motor neurons generates a reproducible and scalable injury that can facilitate quantitative studies on neural regeneration and repair.The efficacy of sciatic nerve suicide transport can also explain neurotoxin-mediated selective loss of motor neurons in diseases such as amyotrophic lateral sclerosis.All procedures were performed at Rutgers under established Institutional Animal Care and Use protocols(eIACUC_TR201800022, approved on March 20, 2018).

Tumor-specific expression of sh VEGF and suicide gene as a novel strategy for esophageal cancer therapy

AIM: To develop a potent and safe gene therapy for esophageal cancer.METHODS: An expression vector carrying fusion suicide gene(y CDgly TK) and sh RNA against vascular endothelial growth factor(VEGF) was constructed and delivered into EC9706 esophageal cancer cells by calcium phosphate nanoparticles(CPNP). To achieve tumor selectivity, expression of the fusion suicide gene was driven by a tumor-specific human telomerase reverse transcriptase(h TERT) promoter. The biologic properties and therapeutic efficiency of the vector, in the presence of prodrug 5-fluorocytosine(5-FC), were evaluated in vitro and in vivo.RESULTS: Both in vitro and in vivo testing showed that the expression vector was efficiently introduced by CPNP into tumor cells, leading to cellular expression of y CDgly TK and decreased VEGF level. With exposure to 5-FC, it exhibited strong anti-tumor effects against esophageal cancer. Combination of VEGF sh RNA with the fusion suicide gene demonstrated strong anti-tumor activity.CONCLUSION: The sh VEGF-h TERT-y CDgly TK/5-FC system provided a novel approach for esophageal cancer-targeted gene therapy.

Rates and risk factors for suicidal ideation,suicide attempts and suicide deaths in persons with HIV:a systematic review and meta-analysis

Background People living with HIV/AIDS(PLWHA)must contend with a significant burden of disease.However,current studies of this demographic have yielded wide variations in the incidence of suicidality(defined as suicidal ideation,suicide attempt and suicide deaths).Aims This systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.Methods Publications were identified from PubMed(MEDLINE),SCOPUS,OVID(MEDLINE),Joanna Briggs Institute EBP and Cochrane Library databases(from inception to before 1 February 2020).The search strategy included a combination of Medical Subject Headings associated with suicide and HIV.Researchers independently screened records,extracted outcome measures and assessed study quality.Data were pooled using a random-effects model.Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity.Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.Results A total of 185199 PLWHA were identified from 40 studies(12 cohorts,27 cross-sectional and 1 nested case-control).The overall incidence of suicide completion in PLWHA was 10.2/1000 persons(95%CI:4.5 to 23.1),translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons.The lifetime prevalence of suicide attempts was 158.3/1000 persons(95%CI:106.9 to 228.2)and of suicidal ideation was 228.3/1000 persons(95%CI:150.8 to 330.1).Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease(AIDS),the risk of suicide completion increased by 34 per 1000 persons.The quality of evidence by Grading of Recommendations,Assessment,Development and Evaluations for the suicide deaths was graded as‘moderate’quality.Conclusions The risk of suicide death is 100-fold higher in people living with HIV than in the general population.Lifetime incidence of suicidal ideation and attempts are substantially high.Suicide risk assessments should be a priority in PLWHA,especially for those with more advanced disease.

A Probe into Ernest Hemingway's Suicide Enigma Through His Works and Life Experiences

Ernest Hemingway, one of the brightest stars on the literary stage of both American and the whole world literature in the twentieth century, had gained an everlasting reputation by the image of"the tough man"he created in lots of his works.Hence, to readers, Hemingway must be a strong man both physically and mentally. Though Hemingway had passed away, he left us an inestimable literary treasure, and we can draw some lessons from his suicide tragedy. To modern people who are

Trends in suicide by hanging, strangulation, and suffocation in Serbia, 1991-2020: A joinpoint regression and age-period-cohort analysis

BACKGROUND Hanging is one of the most commonly used methods for suicide in both sexes worldwide.In a number of countries,hanging mortality has increased over the last decades.Nevertheless,there is a scarcity of studies that have explored the patterns and trends for mortality of suicide by hanging on global,regional and national levels,as most evaluations are limited to certain populations.AIM To assess the trends of suicide mortality by hanging,strangulation,and suffocation in Serbia,from 1991 to 2020.METHODS This nationwide study,with epidemiological descriptive study design,was carried out based on official data.The age-standardized rates(ASRs,expressed per 100000 persons)were calculated by direct standardization,using the World Standard Population.Mortality trends from suicide by hanging were assessed using the joinpoint regression analysis:The average annual percent change(AAPC)with the corresponding 95%confidence interval(95%CI)was calculated.Age-period-cohort analysis was performed to address the possible underlying reasons for the observed suicide trends.RESULTS Over the 30-year period studied,there were 24340 deaths by hanging(17750 males and 6590 females)in Serbia.In 2020,the ASR of deaths by hanging was 4.5 per 100000 persons in both sexes together(7.6 in males vs 1.7 in females).The trends of suicide mortality by hanging decreased significantly between 1991 and 2020 in both males(AAPC=-1.7%per year;95%CI:-2.0 to-1.4)and females(AAPC=-3.5%per year;95%CI:-3.9 to-3.1).Mortality rates of suicide by hanging had a continuously decreasing tendency in both sexes together in all age groups:The only exception was among males in 40-49 age group,with an increasing trend of suicide by hanging from 1991 to 2011(by+0.3%per year).CONCLUSION The trends in suicide mortality by hanging have been decreasing in Serbia in the last three decades in both sexes,but this was more pronounced in women than in men.Despite the decreasing trends observed in mortality of suicide by hanging,further research is needed for better clarification of trends and help in suicide prevention in the future.

Five High-risk Factors for Inpatient Suicide

Objective： The aim of this study was to identify the risk factors for inpatient suicide in a general hospital. Methods： Thirty suicide victims were drawn from the adverse event reports of suicidal acts during hospitalization in a general hospital from 2008 to 2014. Data were gathered from a focus group interview of 6 medical staff who had experienced inpatient suicide. Interpretative phenomenological analysis was used to analyze the data. Results： Five main themes regarding high-risk factors for inpatient suicide emerged from this study： mental disorders, diseases, the source of money to meet medical expenses, social support, and the hospital environment. Patients with mental disorders were at a high risk of suicide. Having a serious disease, paying high medical expenses alone, the loss of social support and unsafe hospital environments were also associated with an increased risk of suicide. Conclusions： This study puts forward different perspectives on the reasons that inpatients commit suicide and corresponding preventive measures based on these 5 main themes that could be implemented to avoid or reduce suicidal acts among inpatients during hospitalization.