Suicide & life-threatening behaviorSamuel McKay, Christina Ng, Jennifer Nicholas, Vivienne Browne, Gina Chinnery, Isabella Choi, Bailey Nation-Ingle, Kristal Allison, Ella Perlow, Michelle Lambl…
BACKGROUND: International students frequently report suicidal thoughts, yet often do not access support. Bud is a co-designed, self-guided mobile app developed as an upstream suicide-prevention intervention targeting transdiagnostic mechanisms related to suicide risk. AIM: To evaluate the effectiveness, acceptability, engagement, and safety of Bud compared with an active and structured psychoeducational comparator. MATERIALS AND METHODS: A two-arm, parallel-group randomized controlled trial was conducted with international students in Australia. Participants were randomized 1:1 to Bud (n = 156) or psychoeducational fact sheets (n = 156), completing assessments at baseline, 2 weeks and 4 weeks. The primary outcome was psychological distress (K10). Secondary outcomes included help-seeking intentions, interpersonal risk processes, emotion regulation, suicidal ideation, and mental health literacy. Analyses used intention-to-treat mixed-effects models. RESULTS: Contrary to the hypotheses, psychological distress decreased from baseline to 4 weeks (Bud: -2.23; Comparator: -2.15), with no group × time interaction (F(2,342.45) = 0.43, p = 0.652); emotion regulation and suicidal ideation showed similar patterns across groups, and other secondary outcomes remained stable across groups. As expected, Bud was rated as enjoyable, worthwhile, and usable. Engagement was moderate (median 10 activities), and no iatrogenic effects occurred. CONCLUSION: Bud was feasible, acceptable, and safe but did not outperform an active psychoeducational comparator over 4 weeks. TRIAL REGISTRATION: ClinicalTrials.gov identifier: ACTRN12625000584437.
The lancet. PsychiatryCathryn Rodway, Su-Gwan Tham, Pauline Turnbull, Nav Kapur, Louis Appleby
BACKGROUND: Suicide in young people is a global priority and strengthening mental health support in education is central to England's suicide prevention strategy. Few studies have examined in detail the individual characteristics of higher-education students nationally who died by suicide. We aimed to describe individual and institutional characteristics of suspected student suicide, contact with support services, and adherence to sector guidance on serious incident investigations. METHODS: We used a national case-series design to identify suspected suicide deaths in higher-education students in the 2023-24 academic year (from Aug 1, 2023, to July 31, 2024). Anonymised serious incident reports were obtained from higher-education providers in England. Data were systematically extracted using a structured pro forma developed with bereaved families and sector organisations and charities. Serious incident reports were also assessed for adherence to national guidance. FINDINGS: Higher-education providers in England informed us of 107 suspected suicide deaths during the 2023-24 academic year. A serious incident report was completed for 86 of these deaths, of which 79 were obtained from 50 providers. Most students who died were men (50 [71%] of 70 with available data were men and 18 [26%] were women). Where known (n=24), mean age was 23·9 years (SD 7·0; range 19-47). Ethnicity was unknown for most students (70 [89%] of 79). Most students were undergraduates (45 [71%] of 63) who lived away from home (44 [72%] of 61). 11 (22%) of 50 deaths with available data occurred in university-managed or privately managed student accommodation. Six reports indicated potential suicide clusters. Mental health difficulties (45 [62%] of 73), academic problems (38 [52%] of 73), and neurodivergence (30 [41%] of 73) were the most common features reported before death, often alongside relationship problems (24 [33%] of 73), self-harm (16 [22%] of 73), social isolation (11 [15%] of 73), housing or financial problems (15 [21%] of 73), and violence (nine [12%] of 73). 52 (69%) of 75 students had previous contact with university support services, although reports highlighted recurring issues with access to support, information sharing, monitoring engagement, and joint working between academic and pastoral supports. Despite national guidance, family involvement in serious incident investigations was only reported for 19 (24%) of 79. INTERPRETATION: A range of actions, including prioritising mental health on campus and offering targeted support to those at risk (eg, neurodivergent or financially insecure students) could contribute to suicide prevention. Universities should ensure the safety of accommodation and routinely involve families in an independent investigation process, promoting openness and transparency from the earliest point. FUNDING: UK Department for Education.
Suicide & life-threatening behaviorJetta E Hanson, Ryan Clarke, Peter M Gutierrez
BACKGROUND: Community Helper Training (CHT) equips people to identify and support individuals thinking about suicide. Most CHT occurs in person, but interest in online delivery is growing. Living Works Start is a 90 min online CHT designed to improve recognition of warning signs, confidence, and willingness to help. AIMS: Evaluate learning outcomes from Start using quality assurance (QA) data, examine the efficacy of online CHT, and determine if prior suicide prevention training influences gains. METHODS: Pre- and post-training surveys from 44,003 learners assessed willingness to talk, ability to recognize signs, confidence to help, and knowledge of how to get help. Paired t-tests and effect sizes examined changes. Subgroup analyses explored differences by quantity and recency of prior training. RESULTS: Significant improvements were observed across all outcomes (p < 0.001). Learners with no prior training showed the greatest gains, though all improved. LIMITATIONS: QA data lacked randomization, comprehensive demographics, and follow-up, limiting generalizability, understanding of skill use, or long-term retention. CONCLUSIONS: Start was associated with self-reported learning gains. Benefits were observed across learners and were strongest among those with no or more distant prior training. Future research should test efficacy under controlled conditions and examine long-term outcomes and real-world use of skills.
INTRODUCTION: Passive suicidal ideation (SI) is a well-established risk factor for suicidal behavior but has received less attention than active SI. Although recent work has leveraged intensive longitudinal data and machine learning (ML) to forecast short-term risk for active SI, passive SI remains understudied as a prediction target. METHODS: Seventy-eight psychiatrically hospitalized youth (ages 13-17 years) completed baseline assessments and daily ratings of risk and protective factors for 28 days post-discharge. Multiple ML models were trained to predict the presence of next-day passive SI. Models with and without baseline variables were compared to assess the relative predictive value of time-varying versus baseline features. RESULTS: ML models predicted next-day passive SI with high accuracy (AUC = 0.90). The strongest predictors were within-person 7-day moving averages of passive SI duration and frequency. Including baseline variables had negligible performance impact, even during initial days post-discharge. CONCLUSIONS: Short-term passive SI remains an underutilized but important target for suicide prevention. Forecasting next-day passive SI using ML is feasible and highly accurate. Within-person, time-varying features outperformed baseline factors, even in early days post-discharge. Additional research on SI facets, such as duration, is needed. Integrating passive SI into personalized intervention frameworks may enhance the precision of suicide prevention efforts.
BACKGROUND: Temporal fluctuations in distress and suicidal ideation across daily, weekly, and seasonal cycles may influence the use and effectiveness of digital suicide prevention tools. Understanding patterns of app engagement, perceived suffering, and affective expression can inform the design of proactive, personalized digital interventions, thereby impacting adherence and efficacy. OBJECTIVE: This study aimed to examine temporal patterns of engagement with 2 core components of the suicide prevention app SERO (Suicide Prevention: a Uniform Effort, Resource-Oriented; BFH, Lucerne Psychiatry), specifically the safety plan and the PRISM-S (Pictorial Representation of Illness and Self-Measure-Suicidality) self-assessment, using 3 years of interaction log data, assessing variations across circadian, weekly, and seasonal cycles, and evaluating the sentiment of free-text responses submitted immediately after PRISM-S self-assessments. METHODS: We analyzed anonymized interaction logs from the SERO app collected over 3 years (November 2022 to December 2025). Engagement metrics included the frequency of use of the safety planning functionality and PRISM-S self-assessment entries. Free-text responses provided after PRISM-S assessments were analyzed using automated sentiment classification. Temporal analyses examined variations by the hour of the day, day of the week, and season. One-way ANOVAs, post hoc tests, and Pearson correlations were used to examine patterns and associations between perceived suffering and sentiment. RESULTS: A total of 1076 users engaged with the safety planning functionality of the SERO app, generating 3502 entries, with coping strategies and warning signs showing the highest mean interactions and personal beliefs the lowest. Separately, 1212 app users accessed the PRISM-S self-assessment, producing 2329 entries (mean distance 12.91, 95% CI 12.39-13.42 cm), with most app users recording only 1 or 2 registrations. Safety planning engagement showed clear diurnal patterns, peaking in the afternoon (2 PM to 3 PM) and being lowest at night (midnight to 3 AM), whereas PRISM-S scores were stable across time. Sentiment analysis revealed predominantly negative affect (mean score of -0.41, SD 0.51, 95% CI -0.44 to -0.39), correlated with PRISM-S distance, and was most negative at night (specifically at 11 PM) and during the afternoon (2 PM to 5 PM). Seasonal effects were small but significant for PRISM-S, with the lowest perceived suffering in summer. CONCLUSIONS: Digital suicide prevention tools can support routine patterns of coping behavior, but periods of increased reported distress, particularly at night, may be underaddressed. Integrating automated sentiment analysis alongside self-assessments could potentially enable personalized, time-adaptive interventions that detect changes in emotional state and deliver timely, tailored support, thereby strengthening proactive engagement and resilience.
PloS oneBridget Hogg, Evelien Coppens, Daniela L Gatto, Cristina de Córdoba-Gil, José Luis Ayuso Mateos, Keti Bakiu, Aileen Callanan, Arlinda Cerga Pashoja, Virgínia C…
Depression and suicide are leading public health problems requiring complex multilevel interventions. This study protocol details the COMBINA trial, which expands the evidence-based European Alliance Against Depression (EAAD) Community-Based 4-level intervention to also focus on improving wellbeing and tailored to five groups with increased vulnerability to depression: young people, older people, migrants/refugees, the long-term unemployed, and people with an existing mental health condition. In this prospective, non-randomised controlled trial, the COMBINA project will be newly implemented during a 24-month period, from late 2024 to late 2026, in five regions in Albania, Estonia, Greece, Ireland, and Spain. These regions will be compared to five control regions in the same countries, chosen to reflect a similar context, size, and sociodemographic characteristics. Main outcomes are a comparison between the intervention and control regions in the rates of deaths by suicide and hospitalisations for suicide attempts and the levels of wellbeing, depressive symptoms, anxiety symptoms, depression-related stigma, and willingness to seek psychological help in the general population. A process evaluation and economic evaluation will also be conducted. This intervention protocol also details the steps taken to promote successful implementation across a range of different cultural and regional contexts, with challenges including different existing mental health resources and differing capacities for the population to use digital tools. The COMBINA project includes co-creation, whereby materials and implementation strategy were designed with people from the vulnerable groups. The trial is funded by the European Union (grant agreement no. 101080651 and carried out according to the Declaration of Helsinki. Ethical approval has been obtained in all participating countries. The results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated through COMBINA stakeholders, with participation from the co-creators. This trial protocol (version 1.1, 24/10/2024) was registered in the ISRCTN registry (ISRCTN10521127) on 14/11/2025 (https://www.isrctn.com/ISRCTN10521127).
Physiotherapy research international : the journal for researchers and clinicians in physical therapyCui Yu, Yuwen Lu, Cheng Peng, Ziyi Wang, Ling Shing Wong, Xinchun Dong
BACKGROUND: College students are vulnerable to depressive symptoms, suicidal ideation, sleep disturbance, and stress-related psychological problems. Aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) have each shown therapeutic potential in affective disorders, but evidence on their combined application in college students at suicide risk remains limited, particularly when neurophysiological outcomes are considered. OBJECTIVES: To evaluate the feasibility, safety, and preliminary effects of aerobic exercise combined with rTMS on suicidal ideation, depressive symptoms, sleep, and prefrontal functional activation in college students at suicide risk. METHODS: This prospective single-centre non-randomised controlled pilot study will enrol students aged 18-21 years who are identified as being at suicide risk by the Xinhai University Crisis Intervention System. At-risk participants will enter one of three groups: active rTMS plus aerobic exercise, sham rTMS plus aerobic exercise, or standardised group psychological intervention/usual support. A separately recruited healthy reference cohort will complete the same assessment schedule without active treatment. Active rTMS will be delivered over the left dorsolateral prefrontal cortex at 10 Hz and 120% of the individual motor threshold once daily for 2 weeks. Aerobic exercise will be prescribed at a target heart-rate zone of 135-164 beats/min for 30-60 min per session every 2 days for 2 weeks, with heart rate and adherence objectively monitored. OUTCOME MEASURES: The primary outcomes are changes in the Self-rating Idea of Suicide Scale (SIOSS) total score and Self-rating Depression Scale (SDS) standard score from baseline to week 4. Secondary outcomes include SIOSS and SDS dimensions, total sleep time, task-related and resting-state functional near-infrared spectroscopy (fNIRS) measures, adherence, concomitant care, and adverse events. ETHICS AND DISSEMINATION: The study was approved by the Ethical Review Committee of Yancheng First People's Hospital (Approval No. 2023-K-230) and the Ethics Committee of INTI International University (Approval No. INTI-IU/FHLS-RC/BTCMI/AUGUST2022/003). Findings will be disseminated through peer-reviewed publications and academic conferences. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400079723.
JAMA network openSang Min Lee, Kyoung-Hoon Kim, Kyu-Man Han, Min-Hyuk Kim, Min-Kyoung Kim, Kwang-Yeon Choi, A-La Park, Myungjae Baik, Ah Rah Lee, Peter Jongho Na, Hyeon-Ah Lee,…
IMPORTANCE: South Korea maintains the highest suicide rate in the Organization for Economic Cooperation and Development, with major depressive disorder (MDD) being the leading diagnosis among suicide deaths. Evidence from large-scale randomized clinical trials (RCTs) is limited, particularly for diagnosis-specific, long-term programs in outpatient settings. OBJECTIVE: To evaluate the effectiveness of a structured, hospital-based case management program in reducing suicidal ideation and associated clinical outcomes among patients with MDD. DESIGN, SETTING, AND PARTICIPANTS: This RCT was conducted at 6 general hospitals in South Korea from January 18, 2021, to July 31, 2024. Participants included outpatients 18 years or older with MDD who had current suicidal ideation or a suicide attempt within the past 2 months. All efficacy analyses were performed according to the intention-to-treat principle. INTERVENTION: Participants were randomized 1:1 to receive either 6 months of structured assertive case management (ACM) as an adjunct to standard treatment (n = 158) or usual psychiatric care alone (control [n = 156]). MAIN OUTCOMES AND MEASURES: The primary outcome was the change from baseline to 6 months in the overall severity of suicidal thoughts and behaviors (STBs), as assessed by the Columbia-Suicide Severity Rating Scale (C-SSRS). Secondary outcomes included changes in depression, suicidal intent and ideation, anxiety, loneliness, impulsivity, quality of life, and service utilization. RESULTS: Of 314 participants enrolled (mean [SD] age, 32.3 [13.1] years; 207 [65.9%] female), 158 were randomized to the ACM group and 156 to the control group; 245 (132 in the ACM and 113 in the control groups) completed the 6-month follow-up. The ACM group showed a significantly greater mean (SD) reduction in C-SSRS total score than the control group (-9.22 [0.49] vs -7.23 [0.50]; adjusted mean difference, -1.99 [95% CI, -3.37 to -0.61]; P = .005). Greater mean improvements were also observed in the ACM group for depressive symptoms (Hamilton Depression Rating Scale mean [SD] change, -9.19 [0.70] vs -6.23 [0.69]; P = .003), suicidal ideation (Beck Scale for Suicidal Ideation mean [SD] change, -7.96 [0.62] vs -5.58 [0.75]; P = .01), and anxiety (Generalized Anxiety Disorder-7 mean [SD] change, -3.90 [0.44] vs -1.85 [0.48]; P = .002). No significant between-group differences were observed in suicide attempts, and 1 suicide death occurred in the control group. CONCLUSIONS AND RELEVANCE: In this RCT of outpatients with MDD and high suicide risk, ACM significantly reduced C-SSRS total scores and psychological distress compared with usual care. These findings provide a critical, high-level evidence base for the national implementation of standardized, hospital-centered psychosocial interventions as a scalable public health strategy for suicide prevention. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0008123.
BMC public healthJohan Fredin-Knutzén, Gergö Hadlaczky, Anna-Lena Andersson, Marcus Sokolowski
BACKGROUND: Over 700,000 suicides occurring globally each year are a major public health issue. Railways and metros provide a lethal means of suicide, mainly occurring by persons under train (PUT) events. Restriction of means has been shown to be effective in reducing suicides and is increasingly being prioritized in railway settings, e.g., using physical barriers. Here, we instead investigated the changes in suicidal behavior on metro platforms following the implementation of an AI-based CCTV detection system. METHODS: We used longitudinal data about PUT due to suicidality in the Swedish metro system in Stockholm (2010-2025). A controlled interrupted time series (CITS) analysis, as well as uncontrolled analyses, were used to test if an AI-CCTV implementation in Q4 2021 (at 14 stations) was associated with decreased rates of PUT due to suicidality, compared to the other 86 stations as controls. We also evaluated secondary outcomes (e.g., suicide deaths and train-traffic cancellations). Sensitivity analyses assessed the robustness of the primary model. A separate exploratory analysis examined an extended post-period, which included multiple heterogeneous system-wide exposures. RESULTS: Rates of PUT due to suicidality were lower after AI-CCTV implementation, in analyses with (IRR = 0.27, p < 0.05) or without (IRR = 0.41, p < 0.05) controls. Secondary outcomes showed consistent point estimates, e.g. death by suicide after PUT (IRR = 0.3), safeguarded individuals (IRR = 0.8) and less cancelled train-kilometers in the metro system. The robustness of the changes in PUT and death by suicide outcomes were confirmed by Bayesian sensitivity analyses using weak priors. CONCLUSIONS: Implementation of AI-CCTV as described herein was associated with lower rates of PUT due to suicidality at metro stations, as well as changes in the same direction for e.g. deaths by suicide and less cancelled train-kilometers. This preliminary study of AI-CCTV in the metro system provides a specific example of how such an intervention may support suicide prevention in the metro system, at least in the short-term.
JAMA network openMarie-Claude Geoffroy, Elizabeth Baker-Sullivan, Nusrat Jahan Nitu, Alessia Civita, Jill Boruff, Mark Sinyor, Jo Robinson, Kathleen MacDonald, Lauren Anzarouth…
IMPORTANCE: Risk and protective factors for suicide mortality in youths remain poorly synthesized, as prior reviews have focused on all ages or nonfatal outcomes. OBJECTIVE: To systematically assess factors associated with risk of suicide mortality in youths. DATA SOURCES: MEDLINE, PsycINFO, Embase, and CINAHL from inception to March 7, 2025. STUDY SELECTION: Case-control and cohort studies of youths (aged ≤24 years) examining risk and/or protective factors associated with suicide mortality vs living general-population controls were included. Two independent reviewers screened 9497 records. DATA EXTRACTION AND SYNTHESIS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 reviewers independently screened reports; 1 extracted data, verified by a second. Evidence was synthesized using vote counting and random-effects meta-analysis in April 2026. MAIN OUTCOMES AND MEASURES: The primary outcome was suicide mortality at age 24 years or younger. RESULTS: Ninety reports from 68 studies, mostly from high-income countries, identified distinct risk and/or protective factors; 54 reports contributed to 30 meta-analyses. The factors associated with the highest odds of suicide risk included schizophrenia (odds ratio [OR], 22.23; 95% CI, 12.05-41.03; I2 = 85.4%; 7 reports), mood disorders (OR, 11.32; 95% CI, 6.11-20.97; I2 = 64.6%; 7 reports), and self-harm (OR, 14.06; 95% CI, 5.58-35.39; I2 = 90.1%; 10 reports). Clinical indicators of health care use were also associated with higher risk, including mental health services use in preceding year (OR, 7.39; 95% CI, 6.45-8.47; I2 = 0.0%; 5 reports) and psychiatric admission (OR, 31.96; 95% CI, 13.83-73.86; I2 = 94.8%; 6 reports). At the socioecological level, several indicators were associated with higher risk, including maltreatment (OR, 4.03; 95% CI, 1.41-11.50; I2 = 67.1%; 5 reports), out-of-home placement (OR, 4.47; 95% CI, 2.15-9.28; I2 = 42.1%; 5 reports), youth justice system involvement (OR, 2.70; 95% CI, 1.94-3.75; I2 = 64.2%; 7 reports), and low educational attainment (OR, 2.95; 95% CI, 1.66-5.24; I2 = 76.0%; 5 reports). In contrast, indicators of family stability were associated with lower risk, including living with both parents (OR, 0.55; 95% CI, 0.48-0.62; I2 = 12.1%; 11 reports). Heterogeneity was substantial across analyses, while Newcastle-Ottawa ratings indicated moderate-to-high study quality. CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, suicide mortality in youths was associated with mental disorders, health care contact, and adversity, supporting both clinical care and population-level prevention, with future research needed in underrepresented populations.
Sociology of health & illnessBaptiste Brossard, Ivan Garrec
This article examines how French general practitioners (GPs) navigate suicide-related referrals within a healthcare system strained by austerity. Drawing on repeated interviews with 29 GPs and a mind-mapping methodology, it shows that referral practices are shaped less by formal clinical pathways than by local resource configurations and the workarounds practitioners develop in response to them. The analysis highlights three interrelated dynamics. First, GPs rely on a sense of technical mastery-an embodied, experience-based judgement of what they can manage-which is continually stretched as they assume responsibilities once assigned to specialists. Second, they operate with expectations inherited from a previously better-resourced institutional network, generating tensions between normative ideals of care and limited referral possibilities. Third, in this context, local social capital becomes an essential resource: Personal relationships, informal networks and accumulated local knowledge decisively structure how practitioners deal with patients deemed suicidal. Situating these dynamics within the concept of suicidescape, this article advances a locally anchored sociology of suicide prevention.
Despite public health strategies focusing on men's mental health and suicide risk, rates of suicide among men remain concerningly high. Targeted, specialized approaches for high-risk individuals should be prioritized alongside broader population-level strategies.
BACKGROUND: Safety planning is recognized as one of the most effective interventions for reducing suicidal behaviors. The quality of safety plans strongly depends on professional training, and traditional methods, such as role-playing, are time-consuming and offer limited opportunities for repetition across diverse patient profiles. Generative artificial intelligence (GenAI) may provide innovative solutions by offering accessible, flexible, and realistic training environments. OBJECTIVE: This pilot study aimed to evaluate the acceptability and feasibility of a GenAI-based simulator designed to train mental health professionals in safety planning. METHODS: Twenty nurses and nursing assistants from psychiatric units in a French university hospital participated in a pre-post, single-session evaluation. After self-rating their ability, competence, and willingness to manage patients experiencing suicidal ideation, participants interacted individually with the text-based simulator for 20 minutes to perform a safety plan with a chatbot, then completed postsimulation acceptability items, and open-ended feedback. Composite scores were computed: acceptability (eg, helpfulness; 0-40), realism (eg, looking like real interaction with patient; 0-20), and challenge (eg, emotional challenge; 0-30). Pre-post changes were tested (Wilcoxon signed-rank test), and age-group comparisons were performed. RESULTS: Acceptability was high (mean 31.9/40, SD 5.3; median 32, IQR 7), realism moderate-to-high (mean 15.1/20, SD 4.1; median 15, IQR 5.25), and challenge manageable (mean 17.0/30, SD 8; median 18, IQR 12.5). Participants rated usefulness (mean 7.65/10, SD 1.57; median 8, IQR 1.57), perceived learning (mean 7.6/10, SD 1.79; median 8, IQR 2), recommendation to use the chatbot for training (mean 8.3/10, SD 1.59; median 9, IQR 2.25), and feedback quality (mean 8.35/10, SD 1.27; median 8.5, IQR 1.25) favorably. Willingness to actively manage patients experiencing suicidal ideation significantly increased postsimulation (P=.03). Younger participants reported higher acceptability (P=.04) and realism (P=.03). Participants reported minimal concerns regarding the simulator's use. CONCLUSIONS: This pilot study demonstrates that a GenAI-based simulator for safety planning is feasible and highly acceptable among experienced mental health professionals. The findings are promising and warrant larger, controlled trials to assess impacts on training effectiveness and patient outcomes.
Behaviour research and therapyLisa M McAndrew, Laura M Lesnewich, Shou-En Lu, David R Litke, Alejandro Interian, Wilfred R Pigeon, Edward A Selby
Individuals with chronic pain have increased risk of suicide, however, few receive suicide prevention interventions. Problem-solving therapy is an evidence-based treatment for chronic pain that seeks to improve problem-solving ability, an executive function associated with suicide risk and related outcomes. The goal of this pilot randomized controlled trial was to estimate if problem-solving therapy improves problem-solving ability and other outcomes for Veterans with chronic pain and moderate suicide risk (n = 44). Veterans were randomized to receive 12-weeks of video delivered problem-solving therapy or supportive psychotherapy. At post-treatment, problem-solving therapy was estimated to result in a greater increase in problem-solving ability (Cohen's d = 0.33, small effect) and a greater reduction in perceived burdensomeness (Cohen's d = 0.60, large effect), compared to supportive psychotherapy. These between-group differences were estimated to be maintained for problem-solving ability (Cohen's d = 0.94, large effect) and perceived burdensomeness (Cohen's d = 0.45, medium effect) at 6-month follow-up. It was estimated that problem-solving therapy did not have a differential effect on thwarted belongingness compared to supportive psychotherapy. In exploratory analysis, problem-solving therapy was estimated to reduce suicide ideation intensity, suicide ideation frequency, and suicide coping at post-treatment, however, in between-group analysis, only suicide ideation frequency was estimated to be reduced as compared to supportive psychotherapy. Results for the exploratory pain outcomes were mixed. This study suggests problem-solving therapy may improve problem-solving ability and reduce feelings of perceived burdensomeness. A fully powered clinical trial is needed to confirm these results and to determine if problem-solving therapy reduces suicide risk and improves pain outcomes.
BMC public healthLan Shi, Sara Sutori, Ulrika Lögdberg, Vladimir Carli, Emma Therése Eliasson
BACKGROUND: Men have 2-4 times higher suicide mortality than women and are less likely to seek help, with disparities linked to restrictive masculine norms and stigma. This review aimed to synthesize the effectiveness of suicide prevention interventions targeting men and identify gender-tailoring strategies. METHODS: Studies evaluating suicide prevention interventions targeting men were included if conducted in male-only samples and reporting outcomes related to suicidality (e.g., suicide deaths, suicide attempts, suicidal ideation), depression, or help-seeking (e.g., behaviors, intentions, attitudes). Six databases (MEDLINE, Embase, PsycINFO, Cochrane Library, Web of Science, and CINAHL) were searched for peer-reviewed English-language studies published up to 31 December 2025. Risk of bias was assessed using RoB 2 and ROBINS-I. Due to heterogeneity, findings were synthesized narratively. The protocol was registered in PROSPERO (CRD420250655554). RESULTS: Seventeen articles evaluating 14 interventions were included. Only one study assessed suicide deaths, and none occurred. Among RCTs, no significant effects were observed for suicide attempts, suicidal ideation, or depression. Help-seeking behaviors and intentions showed mixed evidence of improvement, with no improvement in help-seeking attitudes. Gender-tailoring strategies were synthesized into seven categories: intervention design and development, risk targeting, content and messaging, outreach and recruitment, delivery modalities, male representation and role modeling, and communication and action orientation. CONCLUSIONS: Evidence for the effectiveness of suicide prevention interventions targeting men remains limited, with no clear effects on suicidality or depression and mixed evidence for improvements in help-seeking. Risk of bias was generally moderate to high. A wide range of gender-tailoring strategies was identified. Further development of gender-responsive approaches and more rigorous evaluation are needed to reduce male suicide mortality.
NEJM catalyst innovations in care deliveryHonor Hsin, Santiago Papini, Yun Lu, Heather Clancy, Megan Erion, Carrie Lee, Kimberly Brochard-Des Roches, Jinghui Ju, Kristine Girard, Maria Koshy, Sameer Aw…
Suicide rates in the United States have increased steadily over the past 20 years, a trend coinciding with rising use of mental health services across the country. To help patients before a suicide attempt, health systems must be able to screen for suicide risk and take action at a large scale. Recently, powerful machine learning (ML) models have emerged that can accurately predict suicide attempts by using historical electronic health record data, and yet there exists no standardized framework for implementing these models in care delivery. In this article, the authors present a case study describing the deployment of a suicide risk prediction model within a large virtual mental health care program at Kaiser Permanente Northern California that handled more than 5000 intake visits per month. Their approach used data science to evaluate model validity for their novel use case (intake visits). They integrated patient and clinician voices to design a model-augmented suicide assessment workflow, which they tested iteratively with continuous input from clinician managers. Understanding the opportunities and pitfalls of model-augmented suicide risk assessment from the perspective of patients and clinicians provided an intuitive framework for mapping clinical actions to potential prediction scenarios. This playbook can be applied to ongoing codevelopment of ML uses as part of health systems' continuous learning initiatives, integrating ML to serve today's public health needs. (Funded by a Delivery Science Grant from The Permanente Medical Group.).
BACKGROUND: This study examined the effects of Group Interpersonal and Social Rhythm Therapy (IPSRT) on suicide-related interpersonal constructs (perceived burdensomeness and thwarted belongingness as proxy indicators of suicidal risk) and mood symptoms in patients with bipolar disorder. METHODS: In this quasi-experimental study, 36 patients with bipolar I or II disorder were recruited from psychiatric centres in Isfahan, Iran, and randomly assigned to an experimental group (n = 18) or a control group (n = 18). The experimental group received 12 weekly group sessions of Group IPSRT in addition to standard pharmacotherapy, whereas the control group received pharmacotherapy alone. Suicidal ideation was assessed using the STS-IPTS, and mood symptoms were measured using the Persian version of the Mood Disorder Questionnaire (MDQ). Assessments were conducted at pretest, post-test and follow-up. Data were analysed using repeated-measures ANOVA and MANOVA. RESULTS: Significant time × group interaction effects were found for suicidal ideation, F(1.53, 51.90) = 43.09, p < 0.001, η2 = 0.56, and for perceived burdensomeness, F(2, 68) = 39.75, p < 0.001, η2 = 0.54. Participants receiving IPSRT showed a marked reduction in perceived burdensomeness and thwarted belongingness that was largely maintained at follow-up. For mood symptoms, a significant time × group interaction was found, F(1.68, 57.05) = 12.93, p < 0.001, η2 = 0.28, with the strongest improvements observed in goal-directed behaviour. CONCLUSIONS: Group IPSRT appears to be an effective adjunctive intervention for reducing suicidal ideation and improving selected mood symptoms in individuals with bipolar disorder.
The American psychologistDavid A Jobes, Jeffrey E Barnett
Replies to comments by Paniagua (see record 2027-90077-005) on the original article by Jobes and Barnett (see record 2024-78987-001). The quality of research on psychological interventions for suicide risk and for the use of medications alone and in conjunction with psychological interventions is discussed. Risks associated with medication treatment and benefits of psychological interventions are considered. The need to address the underlying causes of suicidality is emphasized with thoughtful attention to relying on the strongest possible research evidence available today to optimally treat suicidal risk to decrease suffering and help save lives. (PsycInfo Database Record (c) 2026 APA, all rights reserved).