Borderline personality disorder (BPD) is a debilitating condition characterized by pervasive instability across multiple major domains of functioning. The majority of persons with BPD engage in self-injury and up to 10% die by suicide – rendering persons with this condition at exceptionally elevated risk of comorbidity and premature mortality. Better characterization of clinical risk factors among persons with BPD who die by suicide is urgently needed.

We examined patterns of medical and psychiatric diagnoses (1580 to 1700 Phecodes) among persons with BPD who died by suicide (n = 379) via a large suicide death data resource and biobank. In phenotype-based phenome-wide association tests, we compared these individuals to three other groups: (1) persons who died by suicide without a history of BPD (n = 9468), (2) persons still living with a history of BPD diagnosis (n = 280), and (3) persons who died by suicide with a different personality disorder (other PD n = 589).

Multivariable logistic regression models revealed that persons with BPD who died by suicide were more likely to present with co-occurring psychiatric diagnoses, and have a documented history of self-harm in the medical system prior to death, relative to suicides without BPD. Posttraumatic stress disorder was more elevated among those with BPD who died by suicide relative to the other PD group.

We found significant differences among persons with BPD who died by suicide and all other comparison groups. Such differences may be clinically informative for identifying high-risk subtypes and providing targeted intervention approaches.

Suicide-related internet use (SRIU), defined as internet use related to one's own feelings of suicide, can be both a risk and protective factor, especially for isolated individuals. Despite its influence on suicidality, clinicians face challenges in assessing SRIU because of the private nature of internet usage. Current recommendations on enquiring about SRIU in a clinical setting concern mostly young people.

To address the gap in understanding SRIU among patients of all ages, this study aims to explore mental health clinicians’ experiences, attitudes and beliefs regarding enquiring about SRIU, as well as the risks and benefits it presents in the assessment and management of patients. Finally, the study aims to establish the role SRIU potentially plays in the assessment and management of patients.

Twelve clinicians practising at secondary mental health services in England participated in interviews. Thematic analyses were used for data interpretation.

Clinicians who participated in interviews rarely initiate discussions on SRIU with their patients despite considering this an important factor in suicidality. Age of both patients and clinicians has the potential to influence enquiry into SRIU. Clinicians recognise the potential benefits of patients finding supportive online communities but also express concerns about harmful and low-quality online content related to suicide.

Integrating SRIU enquiry into standard clinical practice, regardless of the patient's age, is an important step towards comprehensive patient care. Broader training for clinicians on enquiring about online behaviours is essential to mitigate potential risks and harness the benefits of SRIU in mental health patients.

The aim of this 4-year follow-up study was to examine the predictive effects of demographics, three types of sexual stigma, three types of self-identity confusion, anxiety, depression, family support and problematic Internet use before the coronavirus disease 2019 (COVID-19) pandemic on new-onset suicide risk and persistent suicide risk in young adult lesbian, gay and bisexual individuals who experienced the COVID-19 pandemic in Taiwan.

Baseline data were collected from 1,000 lesbian, gay and bisexual individuals in 2018 and 2019. Outcome data on suicide risk were collected again in 2023. The suicide module of the Mini International Neuropsychiatric Interview was used to assess suicide risk in terms of thoughts of death, desire to self-harm, thoughts of suicide, plans for suicide and suicide attempts in the preceding month at the initial and follow-up assessments. Baseline three types of sexual stigma, self-identity disturbance, depression, anxiety and problematic Internet use were used to examine their prediction of new-onset suicide risk and persistent suicide risk at follow-up.

In total, 673 individuals participated in the follow-up survey. Notably, 16.5% of the participants who had no suicide risk at baseline had new-onset suicide risk at follow-up; 46.4% of the participants who had suicide risk at baseline also had suicide risk at follow-up. Participants who were transgender (p = .003), who perceived greater levels of microaggression (p < .001), and who had greater levels of problematic Internet use at baseline (p = .024) were more likely to have new-onset suicide risk at follow-up. Participants who had greater levels of self-identity confusion were more likely to have persistent suicide risk at follow-up (p = .023).

Intervention strategies for reducing suicide risk in lesbian, gay and bisexual individuals should be developed with consideration of the predictors identified in this study.

The “suicidal transition” from ideation to an act has become a specific topic of research. However, rates in the general population, variations across time and risk factors are unclear.

Data were collected from the phone survey Baromètre Santé among 18–75-year-olds in France. Seven independent samples interviewed between 2000 and 2021 (total N = 133,827 people; 51.3% females) were questioned about suicidal ideation and attempts over the previous 12 months. Transition was calculated as the weighted ratio of attempt on ideation 12-month rates.

Mean 12-month rates of suicidal ideation, attempts and transition were 4.7% (95% Confidence Interval (CI) (4.6–4.8)), 0.5% (95% CI (0.4–0.5)) and 7.7% (95% CI (6.8–8.6)), respectively. Transition rates varied between 4.5 and 11.9% across surveys. In multivariable analyses, higher transitions rates were associated with a previous suicide attempt (adjusted Odds Ratio (aOR) = 11.1 95% CI (7.9–15.6)); 18–25 vs 26–55-year-olds (1.8 95% CI (1.2–2.8)); lower vs higher income (1.7 95% CI (1.0–2.7); and lower vs higher professional categories (aOR around 1.9). No significant association was found with gender, education level, employment status, living alone, urbanicity, current major depression, daily smoking, weekly heavy drinking, cannabis use, and body mass index.

Most people with suicidal ideation do not attempt suicide. These findings emphasize the need to avoid generic terms such as “suicidality”, and to increase research on suicidal transition to improve prevention and prediction. They may also inform the organization of suicide prevention in the general population.

Although immigrants are considered to be vulnerable to mental illness, there is limited knowledge regarding their suicide mortality.

To investigate standardised mortality ratios (SMR) for suicide among the largest immigrant populations in Germany before and after the refugee movement of 2015.

Data on immigrants and the general population in Germany between 2000 and 2020 were provided by the scientific section of the Federal Statistical Office. SMR with 95% confidence intervals were calculated by indirect standardisation for gender, age and calendar year for the pre-2015 and post-2015 time interval, first for all the immigrant populations studied and second for the Syrian, Afghan and Iraqi populations separately.

Immigrants from the countries studied showed a lower suicide risk compared with the German reference population (SMR = 0.38, 95% CI = 0.35–0.41). No differences in SMR were found between pre- and post-2015 time intervals, in either the aggregate data for all populations or the data for Syrian, Afghan and Iraqi populations. Post-2015, Afghan immigrants (SMR = 0.68, 95% CI = 0.54–0.83) showed a higher SMR than Syrians (SMR = 0.30, 95% CI = 0.25–0.36) or Iraqis (SMR = 0.37, 95% CI = 0.26–0.48).

Despite the many and varied stresses associated with flight, comparison of the pre- and post-2015 time intervals showed that the suicide risk of the populations studied did not change and was considerably lower than that of the German reference population. We attribute this to lower suicide rates in the countries of origin but also to flight-related selection processes that favour more resilient individuals.

We aimed to report an overview of trends in suicide mortality and years of life lost (YLLs) among adolescents and young adults aged 10–24 years by sex, age group, Socio-demographic Index (SDI), region and country from 1990 to 2021 as well as the suicide mortality with age, period and birth cohort effects.

Estimates and 95% uncertainty intervals for suicide mortality and YLLs were extracted from the Global Burden of Diseases Study 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) to describe the mortality and rate of YLLs trends. Age, period and cohort model was utilized to disentangle age, period and birth cohort effects on suicide mortality trends.

Globally, suicide mortality and the rate of YLLs among adolescents and young adults both declined from 1990 to 2021 (AAPC: −1.6 [−2.1 to −1.2]). In 2021, the global number of suicide death cases was 112.9 thousand [103.9–122.2 thousand] and led to 7.9 million [7.2–8.6 million] YLLs. A significant reduction in suicide mortality was observed in all sexes and age groups. By SDI quintiles, the high SDI region (AAPC: −0.3 [−0.6 to 0.0]) had the slowest decline trend, and low-middle SDI region remained the highest suicide mortality till 2021 (7.8 per 100,000 population [6.9–8.6]). Most SDI regions showed generally lower period and cohort effects during the study period, whereas high SDI region showed more unfavourable risks, especially period and cohort effects in females. Regionally, Central Latin America (AAPC: 1.7 [1.1–2.3]), Tropical Latin America (AAPC: 1.5 [0.9–2.0]), High-income Asia Pacific (AAPC: 1.2 [0.7–1.7]) and Southern sub-Saharan Africa (AAPC: 0.8 [0.4–1.2]) had the significance increase in suicide mortality. In 2021, Southern sub-Saharan Africa had the highest mortality (10.5 per 100,000 population [8.6–12.5]). Nationally, a total of 29 countries had a significant upward trend in suicide mortality and rate of YLLs over the past three decades, and certain countries in low-middle and middle regions exhibited an extremely higher burden of suicide.

Global suicide mortality and the rate of YLLs among adolescents and young adults both declined from 1990 to 2021, but obvious variability was observed across regions and countries. Earlier mental health education and targeted management are urgently required for adolescents and young adults in certain areas.

Suicide and suicidal behaviour strongly contribute to overall male youth mortality. An understanding of worldwide data contextualises suicide and suicidal behaviour in young men within any given country.

Members and colleagues of the World Federation of Societies of Biological Psychiatry’s Task Force on Men’s Mental Health review the relevant data from several regions of the world. The review identifies notable findings across regions of relevance to researchers, policymakers, and clinicians.

Male suicide and suicidal behaviour in adolescence and emerging adulthood within North America, Latin America and the Caribbean, Europe, the Mediterranean and the Middle East, Continental Africa, South Asia, East Asia, China, and Oceania share similarities as well as significant points of divergence.

International data provide an opportunity to obtain a superior understanding of suicide and suicidal behaviour amongst young men.

Questions often follow the suicide of someone who presented to general adult psychiatry (GAP) when expressing suicidal thoughts: ‘Why were they not admitted, or managed differently, when they said they were suicidal?’ Answering these questions requires knowledge of the prevalence of suicidal ideation in patients presenting to GAP. Therefore, we determined the general clinical characteristics, including suicidal ideation, of a large sample of patients presenting to a GAP emergency assessment service or referred as non-emergencies to a GAP service.

Suicidal ideation was very common, being present in 76.4% of emergency presentations and 33.4% of non-emergency referrals. It was very weakly associated with suicide, varied between different diagnostic categories, and previous assessment by GAP did not appear to affect it. The suicide rate during the contingent episode of care was estimated as 66 per 100 000 episodes.

This, and other evidence, shows that suicide cannot be predicted with an accuracy that is useful for clinical decision-making. This is not widely appreciated but has serious consequences for patients and healthcare resources.

Domestic abuse is a significant risk factor for self-harm and suicide. A large proportion of people presenting to healthcare services following self-harm have experienced domestic abuse. In the UK, routine enquiry for domestic abuse is recommended for people who present having self-harmed, but evidence indicates that this is not happening.

An exploratory qualitative study to explore liaison psychiatry staff experiences of asking about domestic abuse, including the barriers and challenges to asking.

Semi-structured qualitative interviews with active adult liaison psychiatry staff in the UK. Recruitment was via online platforms and professional networks. A reflexive thematic analysis of the narratives was carried out.

Fifteen participants were interviewed across a variety of disciplines (ten nurses, four doctors, one social worker). The generated themes include the following: asking about domestic abuse – the tension between knowing and doing; ‘delving deeper’ and the fear of making things worse; the entanglement of shame, blame and despondency; domestic abuse was different from other clinical problems (mental illness/substance misuse); and biases, myths and misassumptions guiding practice. Participants indicated the need for better training and education, and clear protocols for eliciting and acting on disclosures.

There is a clear need to improve the support offered to victim-survivors of domestic abuse who self-harm and present to healthcare services. National implementation of education and training to better equip liaison psychiatry teams with the skills and knowledge to sensitively support victim-survivors of domestic abuse is required.

The Republic of Cyprus has recorded the greatest increase in suicide mortality among Eastern Mediterranean countries, with an average annual increase of 5.1% in 2000–2019.

To investigate trends in suicide mortality rates between 2004 and 2020 in the Republic of Cyprus, with a focus on age, gender and suicide methods.

Suicide deaths (ICD-10 taxonomy, including ‘undetermined’ code) and population denominators were obtained from the National Mortality Registry and Statistical Office, respectively. Directly standardised (European Standard) mortality rates were calculated for four gender and age groups. Annual change was estimated using Poisson regression models with interaction terms to assess differential trends over different time periods.

There were 560 suicide deaths; these were four times more frequent in men, and approximately 80% were classified as ‘violent’ for both genders. The male suicide rate doubled from 4–5 to 9–10 per 100 000, mostly before 2012, representing a 9% annual change (rate ratio = 1.09, 95% CI 1.03, 1.15; P = 0.002). From 2013, the trend reversed (effect modification P < 0.001) with a 4% annual decrease (95% CI −9%, 1%). Declines were not uniform across all age groups; rates in males aged 45–64 years continued to rise, surpassing the previously high rate in males aged 25–44 years. Rates in females declined from 4–5 per 100 000 to 2–3 over the study period. Overall, the male-to-female suicide rate ratio was 5.33 (95% CI 3.46, 8.19) in 2017–2020, compared with 2.73 (1.88, 3.95) in 2004–2008.

Although suicide rates remain relatively low, the gender differential has widened in the Republic of Cyprus. Further analysis of trends in relation to unemployment and other socioeconomic indicators is warranted.