The addictive behaviors can be seen as attachment disorders. In literature studies about the relationship between attachment styles and addictions are few. However, in addicted patients the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.

To study the relationships between different attachment styles and types of addiction (chemical or behavioral).

To examine the role of attachment styles in patients with alcohol dependence (AD) or pathological gambling (PG).

We recruited 29 with AD and 33 with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered for the study of attachment styles.

PG compared to AD has higher raw scores both anxiety factor (P < 0.001) and avoidance factor (P = 0.003) at ECR. ECR ambivalent correlates with the diagnosis of PG (P = 0.010); ECR avoidant correlates with AD (P = 0.006); ECR anxiety shows a trend of correlation with the diagnosis of AD (P = 0.052). The subjects showed the following attachment styles (Table 1).

This is the first study that compares the attachment styles of patients AD and PG. We found differences in attachment styles of the two types of addiction, confirming the need of different approaches and then different types of treatment. Our findings need to be replicated in larger groups, also widening the target of other addictions.

The authors have not supplied their declaration of competing interest.

The addictive behaviors can be seen as attachment disorders. To our knowledge, the literature on the relationship between pathological gambling (PG) and attachment styles is still poorly represented. However, in addicted patients, the identification of secure or insecure attachment styles seems to have serious implications for the therapeutic alliance and the treatment.

To examine the clinical role of attachment styles in the PG patients.

To study the relationships between the different attachment styles and PG and the severity of PG.

We recruited 33 patients with GP according to DSM-IV-TR criteria; all patients were abstinent from addictive behaviors at least since one month, the experiences in close relationships (ECR) was administered to investigate attachment styles, the South Oaks Gambling Screen (SOGS) to investigate the severity of gambling.

The subjects showed the following attachment styles (Table 1). Ambivalent attachment style correlates with high scores to the SOGS (P < 0.001), and with a shorter period of abstinence from PG (P = 0.022). Patients with ambivalent attachment style have increased severity of PG at SOGS, correlating with higher raw score on the anxiety factor of ECR and lower raw score on avoidance factor (for both P = 0.036).

Patients showed ambivalent attachment, and anxiety factor correlates with a greater severity of PG. Attachment style could be a severity index of PG. Our findings need to be replicated in larger groups, also widening the target of other addictions both chemical and behavioral.

The authors have not supplied their declaration of competing interest.

In this study, it was aimed to determine the internet use properties of Adult Attention Deficit Hyperactivity Disorder (ADHD) patients who were followed-up at Haydarpasa Numune Research and Training Hospital, Psychiatry Department; ADHD Outpatient Clinic.

Thirty participants who were diagnosed with adult ADHD aged between 18–31 years rated their ADHD symptoms in childhood retrospectively, using Wender Utah Rating Scale. Patients rated current adult ADHD symptoms with the Adult ADHD DSM-IV-Based Diagnostic Screening and Rating Scale (DSRS) and severity of symptoms measured by Adult ADHD Self-Report Scale (ASRS). Internet addiction (IA) was assessed with Young's Internet Addiction Scale (IAS). It was determined that, none of 30 Adult ADHD patients have been diagnosed with IA.29 of patient have moderate internet use although 1 of patients have risky internet use. The results revealed that total ASRS score (P = 0.020), total Adult ADHD DSM-IV-Based DSRS score (P = 0.036) and the Attention Deficit related properties subscale total score (P = 0.042) were significantly correlated with the IAS total score. Subscale of the self-report scales including; failing to finish schoolworks, chores, or duties at workplace, difficulty of following through on instructions (P = 0.017), restiveness; impaired inhibitory performance (P = 0.017), feeling not confident (P = 0.017), difficulty of managing time (P = 0.047), failing to give close attention to details or making careless mistakes (P = 0.037) are closely relevant to IAS total score.

In conclusion, clinical features, which are characteristic of Adult ADHD could have same shared etiology with IA. Furthermore, ADHD patients are more likely to have an IA diagnosis. However, it was thought that this result had to be supported with studies including larger samples.

The authors have not supplied their declaration of competing interest.

The progress in technology adds to the new ways of communication between people. In our age, online communication has taken the place of face to face communication. People express themselves, become friends and in a way become who they are through the tools of social media. Many biological and psychological factors may affect the choice of people for communicating through social media.

Main objective of this research is to measure the frequency of Internet addiction and it's relationship to social media use and impulsivity.

The population of the study is composed of 117 female (58.5%) and 83 male (41.5%) students between 18–25 years of age from Uskudar University. Barratt Impulsivity Scale and Internet Addiction Scale were used for data collection and measurement of variables.

Among the participants, 97.5% were found to go online everyday. Among the participants, 74.5% went online for social media use. Only 5% of the subjects fitted the criteria for Internet addiction. Thirty-six percent had limited symptoms for Internet addiction. Internet addiction symptoms and impulsivity were positively related. The tool for Internet access did not affect Internet addiction. Those who used a smart phone went online for social media use more commonly than those who used a computer.

It has been debated that social media and the increase in smart phone use may be affecting young people and increase internet addiction rates, however we have found that impulsivity is an important factor for internet addiction as in other types of addiction.

The authors have not supplied their declaration of competing interest.

Adolescents and young adults are a vulnerable population to both alcohol use disorders and depressive major disorder. Use of cognitive-behavioral therapy (CBT) could help in diminishing depressive symptoms severity as well as alcohol dependence severity.

To evaluate CBT efficacy in young adults diagnosed with major depressive disorder and alcohol dependence.

A number of 12 patients, age 23–35, 7 male and 5 female, outpatients, diagnosed with alcohol dependence and major depressive disorder, moderate or mild episodes, according to ICD-10 criteria, were included in a 3 months CBT oriented program. All subjects were evaluated using a Visual Analogic Scale (VAS) for self-evaluation of alcohol problems severity (score ranging from 0 – absent to 10 – extremely severe), AUDIT scale, Hamilton Depression Rating Scale (HDRS) – 17 items, and Global Assessment of Functioning (GAF). Patients participated in 30 minutes individual CBT sessions, twice per week, for 12 weeks. Cognitive restructuring based on patients’ diary, coping skills training, and activation techniques have been applied in the CBT sessions.

After 12 weeks all patients reported decreases on VAS and AUDIT scores, with mean percentages of 55 and 50, while GAF increased with 45%. HDRS scores decreased with 65%. These changes were considered significant when compared to initial values (P = 0.007 for VAS, P = 0.009 for AUDIT, P = 0.012 for GAF and P < 0.001 for HDRS), according to dependent samples t-test P < 0.05, bivariate.

Cognitive-behavioral therapy, focused on cognitive restructuring, coping skills training, and activating techniques is an efficacious intervention in young patients with comorbid depressive and alcohol dependence.

The presenting author was speaker for Astra Zeneca, Bristol-Myers Squibb, CSC Pharmaceuticals, Eli Lilly, Janssen-Cilag, Lundbeck, Organon, Pfizer, Servier, Sanofi Aventis and participated in clinical research funded by Janssen-Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo, Servier.

The other author has not supplied his/her declaration of competing interest.

Insomnia and tobacco use are frequent and important problems in alcohol-dependent patients. However, the relationship between sleep problems and cigarette smoking was not thoroughly investigated in this population.

The purpose of the study was to investigate the relationship between tobacco smoking and severity of insomnia in alcohol-dependent patients in treatment. We also aimed at assessing other predictors of insomnia in this population.

The study group comprised 384 alcohol-dependent patients. Standardized tools were used to assess: tobacco dependence (Fagerström Test for Nicotine Dependence [FTND]), sleep problems (Athens Insomnia Scale [AIS]), severity of alcohol dependence (Michigan Alcohol Screening Test [MAST]) and drinking quantities before entering treatment (Timeline Follow Back [TFLB]). Other comorbid psychiatric symptoms were assessed using Brief Symptom Inventory (BSI) and Barratt's Impulsiveness Scale (BIS-11).

The study group included 79.1% of current smokers, 62% of participants reported insomnia (AIS). The mean FTND score was 6.05 ± 2.18. The multivariate regression analysis revealed that the severity of tobacco dependence was significantly associated with the severity of insomnia (FTND, beta = 0.140, P = 0.013). Other factors associated with insomnia that remained significant in multivariate model were severity of psychopathological symptoms (BSI, beta = 0.422, P < 0.0005) and intensity of drinking (TLFB, beta = 0.123, P = 0.034).

Tobacco use may predict severity of insomnia in alcohol-dependent patients. This finding may have important clinical implications and influence strategies applied in treatment of alcohol use disorders.

The authors have not supplied their declaration of competing interest.

The prevalence of smoking in patients under methadone maintenance therapy is high (85–98%). Most of these patients tend to quit smoking, but only a few of them receive treatment or referred to quit smoking. Recent study on aripiprazole, has been shown to reduce smoking.

The aim of this study was to evaluate aripiprazole on smoking in patients under methadone maintenance therapy.

This study was a double-blind intervention study. Patients under Methadone maintenance therapy in 22 Bahman Hospital randomly divided into two intervention and control group. First with the FTQ questionnaire, nicotine dependency assessed in all patients. Then, 6-week aripiprazole administered to intervention group. Data were analyzed by SPSS version 21.

The age range of patients was 67–25 years. Two groups were matched in demographic characteristics. Finally, mean number of FTQ questionnaire in case group before intervention was 8.9 ± 1.4 and after intervention was 8.4 ± 1.6. This difference was statistically significant (P = 0.0007).

The study results show the aripiprazole effect in reducing the desire to smoke in patients under methadone maintenance therapy. The overall level of dependency on nicotine on the basis of test FTQ has decreased. By choosing aripiprazole as adjunctive therapy to quit smoking, by reducing the tendency of patients to smoking, can decrease cardiovascular complications and other problems caused by smoking and we can reduce the mortality rate of these patients.

The authors have not supplied their declaration of competing interest.

A previous study, conducted in the province of Novara stated that, from an epidemiological and clinical point of view, being a female, being a migrant, as well as being in the warmer months of the year, or suffering from an untreated psychiatric disease are associated with suicide attempts. Literature suggests there is a positive relation between negative life events and suicidal behaviours. In this study, we intend to deepen knowledge, individuating motivations and meanings underlying suicidal behaviours. This appears a meaningful approach to integrate studies and initiatives in order to prevent suicide and suicidal behaviours.

To examine possible correlation between socio-demographic and clinical characteristics and motivations underlying suicide attempts.

Patients aged > 16 years admitted for attempted suicide in the Emergency Room of the AOU Maggiore della Carità Hospital, Novara, Italy, were studied retrospectively from the 1st January 2015 to the 31st December 2016. Each patient was assessed by an experienced psychiatrist with a clinical interview; socio-demographic and clinical features were gathered. Analysis were performed with SPSS.

Data collection are still ongoing; results and implications will be discussed. We expect to find different motivations in relation to socio-demographic and clinical characteristics [1,2].

The authors have not supplied their declaration of competing interest.

Cognitive disorders are associated with a wide range of psychopathological syndromes and behavioral disorders, and suicidal manifestations in dementia are understudied nowadays.

To investigate clinical-psychopathological predictors of a suicidal behavior in patients with dementia.

Forty-four patients with dementia were examined: 23 patients with suicidal manifestations and 21 patients without them (control group). Clinical and psychometrical methods were used: Mini Mental State Examination (MMSE) scale; Assessment of Suicide Risk scale; Hamilton Rating Scale for Depression (HDRS), and statistical ones.

It was determined that male patients with dementia had suicidal behavioral manifestations more often than female patients (69.6%; P < 0.05). An average age of the patients was 69.88 ± 1.85 years with no significant difference between the main and control groups.

The majority of the patients with dementia (52.3%) had suicidal manifestations. Real suicidal intentions were the most frequent (25%; P < 0.05); 20.5% of patients expressed passive thoughts (anti-vital sentences, fantasies, ideas concerning death); 2 patients (6.82%; P < 0.05) had suicidal attempts. Patients with suicidal tendencies in their clinical picture more often had hallucinatory syndrome (39.1%; P < 0.05); features of severe depression (35.04 ± 1.54 points; P < 0.01); a high level of suicidal risk (26.34 ± 1.68 points; P < 0.01); a severe cognitive deficit (ММSE score 0–10); and a significantly lower level of self-awareness of death (18.53 ± 0.72 points; P < 0.05) in comparison with the control group.

A high suicide risk in dementia correlated with a level of depressive symptoms (r = 0.6), moderate and/or severe grades of dementia (r = 0.45), and a low level of self-awareness of death (r = 0.35).

The authors have not supplied their declaration of competing interest.

The great global burden of suicide requires specific preventive strategies focused on emergency services (ES) workers, providing first aid after attempted suicide.

To investigate the approach of ES workers toward attempted suicides, and to assess work-related stress and teamwork attitude as variables likely to influence suicide risk perception.

A total of 265 ES workers (73 medical doctors, 130 nurses, 62 health and social care workers) from 3 hospitals in the area of Modena (Northern Italy) were involved. In a group setting, titles from local newspapers reporting about suicides were read, and ES workers were asked to fill in 3 psychometric scale questionnaires (SUIATT, MBI and SAQ).

The questionnaires returned were 88 (33%), 47% (n = 42) were filled by women, median age was 40 years. Doctors group had the highest response rate (60%). Burnout levels were intermediate at the Emotional Exhaustion subscale, severe at the Depersonalization subscale and mild at the Professional Efficacy subscale. Eighteen percent recorded a good team perception, 33% had a good perception of their work conditions. SUIATT subscales showed a restrictive attitude toward suicide, regardless of hospital and task.

No associations emerged among SUIATT, MBI and SAQ subscales; male sex alone correlated to the SUIATT factor “rationality/mental alteration”, suggesting more “tolerance” of suicidal behaviour.

It is crucial to raise awareness among ES workers on this issue, since those workers considering suicide as “more acceptable” are more likely to recognise its signs.

The authors have not supplied their declaration of competing interest.

Attempted suicide consists in a self-damaging non-fatal behaviour, with an explicit or implicit evidence of the intent to die. It has a multifactorial aetiology: presence of psychiatric disorder, particularly major depression and other non-psychiatric components, like a series of stressful events.

To describe suicidal behavior among patients who attempted suicide.

Cross-sectional study. Patients admitted to three hospitals in the Province of Modena (Italy) after having attempted suicide were enrolled. Observation time: August 2015–August 2016 (13 months). Descriptive statistics made with STATA 13.0.

A total of 187 subjects (female 65%) were enrolled in the period of time considered. Forty-one percent were aged 45–64; 43.7% had higher education; 50.4% were unemployed; 49.6% had regular income. Common means to attempt suicide were drugs (64%), weapons (11%), precipitation (10%), other (6%), choking (4%). Recent stressful events were reported by the 83.4% of respondents, namely: family conflicts (29%), economic problems (17%), personal health problems (11%), health problems affecting a family member (5%), emotional separation (9%), job loss (7%), other (22%), alcohol abuse (27%), substance abuse (4%). The main psychiatric diagnoses were: depressive disorder (56.67%), personality disorder (20%), psychotic disorder (6.67%), bipolar disorder (5.33%), behavioural disorders (2.67%), anxiety disorders (2%), dementia (1.33%).

Findings of the present study are consistent with available literature and could help to identify “high risk” groups to plan future targeted programmes.

The authors have not supplied their declaration of competing interest.

To describe demographic and psychiatric characteristics of suicide victim cases.

Retrospective, case file psychological autopsy of deaths registered at the coroner's court, Dublin. Cases with a verdict of suicide and open verdicts registered in 2007, 2012 and 2013 were included.

Two hundred and five cases of suicide/open verdicts were registered the 3-year period. Seventy four percent (n = 152) were males. Mean age – 42.87 years old (STD = 15.44) with no significant difference between genders. Sixty-four percent (n = 132) were single at the time of death, while 32.2% had children. One hundred and ninety-eight had a stable accommodation; 37.5% (n = 77) living alone, and 36.6% (n = 75) actively employed.

One hundred and twelve subjects (54.6%) suffered from mental illness; 53.6% – affective disorder; 15.2% – alcohol and substance misuse; 12.5% – psychotic disorder. Seventy-nine (70.5%) were not in contact with mental health services at the time of death; 32 (28.6%) were attending as outpatients. Illness onset was recorded for 68.7% cases (n = 77); 35.7% (n = 40) had a length of illness of more than 5 years. Psychiatric comorbidity was present in 29.5% (n = 33); 54.5% (n = 18) presented also alcohol/substance misuse.

Suicide victims were single, middle-aged male, suffered mental health difficulties, most frequently affective disorder. A small number of subjects an additional comorbid diagnosis. Few were in contact with outpatient services at the time of death. No significant differences in demographic characteristics were found between the group suffering from mental illness and the group with no mental illness.

The author has not supplied his/her declaration of competing interest.

Suicidal behaviour and drug and alcohol dependence represent two different aspects of self-destructive behavior.

We evaluated the relationship between suicidal behavior and substance and alcohol addiction. It was investigated the role of childhood trauma in these self-destructive behaviors and in the development of the two mental constructions of hopelessness and mentalization.

We also assessed how a high level of hopelessness could affect suicidal ideation and how low or absent capacity of mentalization could influence the development of substance and/or alcohol addiction.

This naturalistic, observational study included 50 patients (mean age = 46.54; S.D = 14.57) recruited from the department of psychiatry (n = 18) and the centre for suicide prevention (n = 32) of Sant’Andrea Hospital (Rome). Different questionnaires were administered to each patient from February to May 2016.

There was not a statistically significant relationship between suicidal behavior and addict behavior. Childhood trauma resulted a risk factor for alcohol abuse with a relationship that tended to significance (P = 0.07). Physical and sexual abuses were significantly associated with addiction (respectively P = 0.014; P = 0.033). It was showed a statistically significant interaction between high level of hopelessness and suicidal ideation (P = 0.037). The absence of mentalization was related to the absence of alcohol abuse (P = 0.061). Finally, trauma experienced during childhood was associated with high level of hopelessness (P = 0.005).

Suicidal behavior is influenced indirectly by a childhood traumatic experience that conditioning the level of hopelessness. Childhood trauma affected directly the development of drug abuse and alcoholism. The capacity of mentalization was not related with childhood trauma.

The authors have not supplied their declaration of competing interest.

Cyberbullying is an emergent problem associated to terrible consequences, especially in young adults.

To analyse the levels of behaviours of victimization and aggression of cyberbullying, suicidal ideation, mood states and consumption of psychoactive substances in a sample of college students from the University of Beira Interior (UBI), as well as to analyse the relationship between these variables.

Analytical cross-sectional study that integrates quantitative methodology. Data collection took place via online survey in the population of students at the UBI (n = 475, 329 females, mean age 22.2 ± 4.1 years). The questionnaire consisted of socio-demographic, mental health and internet use data and the Portuguese versions of self-reported scales to measure mood states, consumption of psychoactive substances, the levels of behaviours of victimization and aggression of cyberbullying and the levels of suicidal ideation.

The levels of aggression of cyberbullying were significantly higher in male students and in users of social networks. There was a significant positive correlation between behaviours of victimization and aggression of cyberbullying, and between them and suicidal ideation and negative affect. The levels of both behaviours of cyberbullying and suicidal ideation were significantly higher in students consuming alcohol with drugs, just drugs and sedatives. There was a significant positive correlation between suicidal ideation and negative affect and a significant negative correlation between suicidal ideation and positive affect.

Both behaviours of cyberbullying were significantly associated with suicidal ideation and negative affect. Thus, stands out the relevance of an earlier identification of these behaviours and an adequate intervention by health professionals.

The authors have not supplied their declaration of competing interest.

Official rates of suicide are perhaps the most important and enduring measures of population mental health. They are however prone to variations in reporting usually relating to deaths where the intention was uncertain, though most official statistics circumvent this by including ‘events of undetermined intent’ (ICD10 Y10-34 and Y87.2) along with ‘intentional self-harm’ in their official statistics. It is however unclear how successful this strategy has been and whether significant sources of bias still persist.

To systematically examine the dramatic change in rates of death from suicide (and undetermined intent) in Northern Ireland, that coincided with a major overhaul and reorganisation of the Coroners Service in 2005/6, to understand the extent to which the initial investigation by the coroners’ office, legal processing, registration and coding practices can influence official suicide statistics.

In the space of one year, Northern Ireland went from having a standardised rate of suicide (incl undetermined intent) of 12.6/100,000 in 2004 to 26.6/100,000 in 2006 (a 111% increase) and in doing so went from having consistently the lowest to consistently the highest registered rate of suicide in the UK.

Initial analyses rules out changes in the police service, pathology service or registration coding practices as causative and suggest that the introduction of a coroner's liaison officer (with a formal data gathering role) was the most likely factor. The centralisation of the coroners’ service also reduced variations according to age, sex, geography and coding.

The process underpinning official statistics need to be routinely scrutinised.

The authors have not supplied their declaration of competing interest.

The dramatic fluctuations in suicide mortality in the countries of the former Soviet Union (fSU) over the past decades have been widely discussed in the scientific literature and are still relatively unexplored. Accumulated evidence suggests that the mixture of cultural acceptance of heavy drinking, high rate of distilled spirits consumption, and binge drinking pattern is major contributor to the suicide mortality burden in fSU countries.

The present study aims to analyze whether binge drinking is able to explain the dramatic fluctuations in suicide mortality in Russia, Belarus and Ukraine from the late Soviet to post-Soviet period.

Trends in alcoholic psychoses incidence and suicide rates from 1980 to 2015 in Russia Belarus and Ukraine were analyzed employing a Spearman's rank-order correlation analysis.

The estimates based on the Soviet data suggest a strong positive association between alcoholic psychoses and suicide rates in Russia, Belarus and Ukraine. This positive relationship was less evident in the post-Soviet period.

Collectively, these findings indicate that alcohol has played an important role in the fluctuation of suicide mortality rates in the former Soviet republics during the last decades. Further monitoring of suicide mortality trends in the former Soviet countries and detailed comparisons with earlier developments in other countries remain a priority for future research.

The author has not supplied his/her declaration of competing interest.

Previous studies using a modified Stroop test suggested that suicide attempters, in contrast to depressed patients with no suicidal history, display a particular attentional bias toward suicide-related cues. However, negative results have also been reported. In the present study, we collected new data and pooled them as part of a meta-analysis intended to shed further light on this question.

We conducted:

– a cross-sectional study comparing performance on the modified Stroop task for suicide-related, positively-valenced and negatively-valenced words in 33 suicide attempters and 46 patient controls with a history of mood disorders;

– a systematic review and a meta-analysis of studies comparing performance on the modified Stroop task among patients with vs. without a history of suicidal acts in mood disorders.

The cross-sectional study showed no significant difference in interference scores for any type of words between suicide attempters and patient controls. A meta-analysis of four studies, including 233 suicide attempters and 768 patient controls, showed a significant but small attentional bias toward suicide-related words (Hedges’g = 0.22; 95% CI [0.06 to 0.38]; Z = 2.73; P = 0.006), but not negatively-valenced words (Hedges’g = 0.06; 95% CI [−0.09 to 0.22]; Z = 0.77; P = 0.4) in suicide attempters compared to patient controls.

Positively-valenced words and healthy controls could not be assessed in the meta-analysis.

Our data support a selective information-processing bias among suicide attempters. Indirect evidence suggests that this effect would be state-related and may be a cognitive component of the suicidal crisis. However, we could not conclude about the clinical utility of this Stroop version at this stage.

The authors have not supplied their declaration of competing interest.

According to many studies, suicide attempters, compared to healthy general population, exhibit some neurocognitive deficits, which are considered promising endophenotype of suicidal behavior disorder. A similar pattern of impairment is widespread in individuals affected by psychiatric disorders.

To compare neurocognitive functions of hospitalized suicide attempters (A) with those of an inpatient group without history of suicidal behavior (NA), likewise affected by psychiatric disorders.

The purpose of the study is to evaluate if neurocognitive impairment is associated to suicidal behaviors, regardless of underlying psychiatric diagnosis.

The whole sample is composed of 70 adult psychiatric inpatients (34 males, 36 females), divided into two groups (A and NA) of 35 patients with diagnosis of Psychotic, affective and personality disorders. Neurocognitive functions were assessed using Tower of London Test (TOL), Modified Wisconsin Card Sorting Test (MCST), Stroop Test (ST) and Attentional Matrices (AM). Differences between A and NA groups were analyzed using U-test of Mann–Whitney and cross tabulations, taking into account the three diagnostic areas.

Statistically significant differences were found between A and NA with regard to the ability of categorization (MCST), planning, problem solving and inhibition of automatic response (TOL), which proved to be more preserved in A individuals. No significant differences were found on selective attention tasks (ST and AM).

These preliminary findings show statistically significant differences on executive functions between suicide attempters and psychiatric non-attempter individuals. Further research on larger samples is needed to investigate these associations.

The authors have not supplied their declaration of competing interest.

Only 25% of people who die by suicide see mental health services. Suicide is not just a health issue. Its causation and consequences lie within all of society. Many erroneously believe that suicide is inevitable and not preventable, because its causation is too complex. Underlying associations with suicide are largely social. There are programmes in the USA, which have combined interventions to reduce suicides. The 2014 UK suicide rate per 100,000 was 10.8 but 11.1 in South West (SW) England (pop: 5 million). A whole system approach is necessary. Zero Suicides SW is a project to address this.

(1) To develop a regional strategy to reduce and prevent suicide. (2) To make whole populations suicide risk aware. (3) Reduce regional suicide rates.

A collaborative involving national and local 60 organisations including charities and voluntary sector was formed. Five collaborative meetings used narratives of suicide survivors, national experts led themed workshops, etc. to come up with a regional strategy. Quality Improvement (QI) Methodology was used to develop and examine the success of all projects.

Initiatives such as using local radio stations for mental health promotion, collaboration via a poster campaign with local breweries and pubs to make men more self-aware of risk, suicide risk counselling for relatives/carers of patients admitted to psychiatric care, improving scrutiny to access to medication for recently discharged psychiatric patients have developed from the project. The QI model demonstrated how localised changes at person and organisation level could combine and have a powerful role in suicide prevention.

The authors have not supplied their declaration of competing interest.

To assess suicide risk in elderly psychiatric outpatients and to identify potential suicide risk factors in this population.

This was a cross-sectional, descriptive and analytical study, including 50 psychiatric outpatients, aged 65 years or more and attending the Hédi Chaker University Hospital, in Sfax (Tunisia), between November and December 2015. We used a hetero questionnaire including epidemiological and clinical data and three scales: the Suicidal Risk Assessment Scale of Ducher (RSD), the Hospital Anxiety and Depression Scale (HADS) and the Mini Mental State Examination (MMSE).

The sex ratio (M/F) was 1. The average age of patients was 68.62 years. The majority of them were married (68%), unemployed (98%), living in urban area (58%) and within their family (88%); they had at most a primary degree (80%) and a low socioeconomic level (74%).

The prevalence of patients at risk of suicide (RSD ≥ 3) was 26%. This risk was high (RSD ≥ 7) in 18% of cases.

The presence of suicidal ideation (RSD ≥ 3) was correlated with: a family history of suicide attempt (58.3% vs. 15.8%; P = 0.003), a personal history of suicide attempt (80% vs. 12.5%; P < 0.001), depressive symptoms (HAD-D ≥ 11) (36.7% vs. 10%; P = 0.05) and anxiety (HAD-A ≥ 11) (52.4% vs. 6.9%; P = 0.001).

Our study showed that among older psychiatric outpatients, one in four had suicidal thoughts. This high rate encourages us to search systematically these suicidal thoughts in this population, especially in patients with risk factors such as a family history of suicide attempt, depressive or anxious symptoms.

The authors have not supplied their declaration of competing interest.