Background: Existing evidence poses low self-esteem as a risk factor for both suicidal ideation (SI) and suicide attempts (SAs) in the general population.

The present study assesses the relationship between self-esteem level and SI/SA, considering across the lifespan. Two separate meta-analyses, one for SI and the other for SA are herein reported since they substantially overlap in terms of eligibility procedures and search strategies.

Eligible studies documented at least one suicidal, and a non-suicidal group. Data were analyzed using the Cochrane Collaboration Review Manager Software (RevMan, version 5.4.1) under the random-effects models. Values were standardized owing to the anticipated heterogeneity of self-esteem rating tools. Sensitivity analyses were performed to control for heterogeneity.

Out of 3,310 initial hits, 24 studies were deemed eligible for inclusion. The meta-analyses showed that individuals with lower levels of self-esteem, compared to those with higher levels, were more likely to endorse both SI and SA. SI reached a standardized mean difference of -0.43 (CI: -0.81, -0.05), while SA reduced by -0.89 (CI: -1.02, -0.76), overall. Limitations: The herein presented results rely on standardized mean differences rather than odds of either SI or SA since the original studies failed to systematically fetch rates of the events.

Lower levels of self-esteem represent a risk factor for both SI and SA across the lifespan. Forthcoming studies should systematically account for multiple moderators to allow meta-analytic synthesis including sub-group and meta-regression analyses assuming high-heterogeneity would still be concerned.

No significant relationships.

Depressive disorders are common for cardiac patients; however, a surgical intervention enhances their distress. How typical is suicidal ideation for cardiac surgery patients and with what clinical and psychological signs does it correlate?

To estimate the frequency of suicidal ideation and correlations between suicidal ideation, clinical and psychological manifestations in cardiac surgery patients.

We examined 60 cardiac surgery patients, aged 25 – 65, prior to their operation. The Pierson correlation between manifestation of suicidal ideation, clinical and psychological signs was calculated with p<0.05.

We revealed suicidal ideation in 3.33% of cardiac surgery patients. Its intensity credibly correlated with the frequency of taking alcohol (r=.32), as well as with manifestation of dysorexia (r=.59), dissatisfaction with life (r=.53), general level of depression (r=.49), sleeping disorders (r=.44), sense of guilt (r=.43), asthenia (r=.31), self-abhorrence (r=.29), and irritability(r=.29). A higher level of suicidal ideation correlated with a lower index of Positive-Past in their personal time perspective (r=-.27), which revealed itself in a patient having lack of positive impressions and recollections of their past life, which reduced a person’s adaptability in the present.

The frequency of suicidal ideation in preoperative cardiac surgery patients is not high. Nevertheless, we should bear in mind that high suicidal risk is characteristic for patients with not only depression, but also alcohol problems, as well as for those who have manifestations of negative attitude to their past.

No significant relationships.

Existing literature supports the association between depression and self-harm, a prominent risk factor of suicide.

Аnalysis of psychological characteristics of women with depression and self-harming behavior and their differences from patients with depression without self-harm.

The study involved 62 women with depression (age 16–23), 36 with self-harming, 26 did not have episodes of self-harm. Hamilton Scale (HDRS), Wisconsin Card Sorting Test (WCST), Iowa Gambling Task (IGT), SCL-90-R, Rosenberg self-esteem scale, Body Investment Scale (BIS) were used.

Computer test execution time is shorter in the self-harming group, the total time in WCST and IGT tests is significantly shorter (T Test p<0.001), «inhibition» (HDRS) in this group is significantly lower. The self-harmed group demonstrates higher feelings of guilt (2.222±1.141 versus 1.367±1.326 in the non-self-harm group, p=<0.001), suicidal ideation (2.653±1.302 versus 1.100±1.373 p<0.001), psychopathological symptoms in SCL90-R: sensitivity (1.812±0.861 versus 1.185±0.553), hostility (1.388±0.965 versus 0.729±0.700 p=0.004), GSI (1.539±0.705 versus 1.205±0.473 p=0.039), and a special attitude towards body - a decrease of somatic symptoms (HDRS), decreased parameter of “protection” of body and the «attitude to the body» in Body Investment Scale (BIS).

The study revealed psychological characteristics that distinguish a group of depressed women with self-harming: a mismatch of the severity of the components of depressive tirade - motor and ideator inhibition was less pronounced, while the affective component was significantly more pronounced. The body investment is reduced, the need to protect one’s own body is ignored. High level of guilt, and the increased sensitivity characteristic of these patients can be a vulnerability factor.

No significant relationships.

The bioelectrical activity of the brain of suicidals has specific features.

Investigate neurophysiological features associated with high suicidal risk (SR) in dementias.

An electroencephalographic study of brain was performed in 66 patients with dementia, of which 33 (with high SR) were included in the main group, the other 33 (with low SR) – in the control group.

SR correlates include an increase in the spectral density and amplitude (in μV) of the α-rhythm in the right central (C4) (109.4) – in the main group, compared with (64.5) – in the control; in the temporal areas (T4) (132.2) - in the main group, (70.0) – in the control group (p<0.001). The predominance of the spectral density of the slow θ-rhythm over the entire surface of the brain (p<0.001) and δ-rhythm in the projection of Fp2 (82.3) – in the main and (116.1) – in the control groups (p<0.001), F3 (54.80) and (68.1), respectively, (p<0.05), F4 (52.4) and (67.3), respectively, (p<0.01), C4 (52.0) and (62.0), respectively (p<0.05), P3 (44.4) and (58.9), respectively, (p<0.01), O1 (67.6) and (89.41), (p<0.001), O2 (68.5) and (85.8), respectively (p<0.001) are a predictor of low SR in dementias.

With the progression of changes in the brain in dementias SR decreases. In the initial phases of the dementing process with a relatively preserved functional capacity of the brain SR is high.

No significant relationships.

The approval of the esketamine nasal spray for treatment-resistant depression in March 2019 by the Food and Drug Administration (FDA), and few months later by the European Medicine Agency, triggered a vivid debate and many concerns, mainly because of the lack of convincing evidence on its efficacy and safety, based on the development programs, approval trials and few post-marketing trials.

We aimed to detect and characterize safety signals for esketamine, by analyzing relevant adverse events (AEs) reports in the FDA Adverse Event Reporting System (FAERS) database (March 2019-March 2020).

We performed disproportionality analysis through the case/non-case approach: reporting odds ratios (ROR) and information components (IC) with 95% confidence intervals (95%CI) were estimated for esketamine-related AEs with at least four counts. We compared serious and non-serious AEs using non-parametrical tests.

The FAERS database registered 962 reports of esketamine-related AEs in one year. Signals (i.e., statistically significant disproportionality) were detected for several AEs, such as dissociation, sedation, feeling drunk, suicidal ideation and completed suicide. Signals for suicidal ideation, but not suicide attempt and completed suicide, remained significant when comparing esketamine to venlafaxine. The comparison of patients with serious vs. non-serious esketamine AEs revealed that females, patients receiving antidepressant polypharmacy, co-medication with antipsychotics, mood stabilizers, benzodiazepines or somatic medications were more likely to suffer from serious AEs.

This real-world pharmacovigilance analysis detected signals of serious unexpected esketamine-related AEs, thus reinforcing current worries regarding esketamine safety/acceptability. Further real-world studies are urgently needed to unravel the safety profile of esketamine.

No significant relationships.

Although suicide showed an association with personality disorders, few studies focused on narcissism. This association is interesting, especially in what authors called a “narcissism epidemic”, considering narcissistic wounds to which subjects could be subjected.

To systematically review studies investigating the association between narcissism and suicidal risk.

We focused on the association between narcissism (NPD, narcissistic traits) and suicide (Suicidal Ideation (SI), Non-suicidal Self-Injury (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt (SA) and Suicide (S)). Studies were identified through a PubMed-based search. Reference lists were examined to extract additional articles. This review was performed according to PRISMA Statement.

We included 33 studies. Most studies evaluated narcissism through DSM, showing heterogeneous results. NPD was associated with low impulsivity and high planning, but also with a higher number of SAs. Studies evaluating narcissism as a trait were more coherent. SI, NSSI and DSH showed an association with vulnerable narcissism. These associations were explained by mediation and moderation models including shame and dissociation. The grandiose component was associated with severe repetitive NSSIs and S in high suicidal risk samples. Impulsivity showed no effect.

It is possible to develop hypothesis, even if not causal relationships, on the association between narcissism and suicidal risk. Grandiose narcissism seemed to be protective for suicidal outcomes with low intent to die, while vulnerable narcissism seemed to be associated. However grandiose narcissism seemed to be a risk factor for suicidal outcomes with high intent to die, showing low impulsivity and high planning and severity. New studies, differentiating between narcissistic components, are needed.

According to WHO statistics, 800,000 suicides occur annually, representing the second leading cause of death in people aged 15 to 29. The contributing factors for suicidal risk are multifactorial and multileveled.

We aimed to analyze the predictive value of distinct sociodemographic, personality and symptomatology characteristics in predicting the presence of suicidal risk in patients hospitalized for the analyzed mood disorder.

A longitudinal retrospective case-control study was performed on medical data records of 90 patients admitted in the Timisoara Psychiatric Clinic during 2018 – 2020. Besides the parametric and non-parametric statistical analyses, logistic binary regression analyses were done.

Patients with suicide risk tended to be younger (p = 0.039), without intimate partnership (p < 0.001), current smoker (p = 0.038) and to present psychotic symptoms at some moments during the psychiatric disorder. 51 (56.7%) of the total patients have presented different degrees of suicidal risk (from suicidal ideation to suicide attempt). Patients with suicide risk tended to be younger (p = 0.039), without intimate partnership (p < 0.001), current smoker (p = 0.038) and to present psychotic symptoms at some moments during the psychiatric disorder. Personality traits has not influenced suicidal risk. Presence of intimate partner (OR = 0.135; p < 0.001) and the presence of psychotic symptoms during recurrent depression (OR = 7.309; p = 0.004) have presented predictive value on suicide risk.

Psychiatrist practitioners should be aware of the clinical and sociodemographic characteristics that put recurrent depressive patients at risk of suicidal behaviors.

No significant relationships.

Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk.

We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt.

A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17.

This case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.