Active clinical trials for "Suicide, Attempted"

The goal of this clinical trial is to evaluate a suicide risk model in patients receiving behavioral health care treatment. The main question it aims to answer is: Does the implementation of the suicide risk model reduce suicide attempts? Researchers will compare the outcomes of patients identified by the model to those in a usual care group.

The objective of this controlled, randomized, monocentric study is to compare the response rate of the call at 3 months of the groups with or without short message service (SMS) 48 hours before, for the subjects having benefited from the device "VigilanS Lorraine". The secondary objectives will be to appreciate the satisfaction of the subjects towards the sending of the SMS as well as to compare the delay of suicidal recidivism according to whether the subjects answered or not to the call of evaluation at 3 months of the passage to the act The main question it aims to answer is: What impact, on the rate of successful calls, could sending a text message 48 hours before the 3-month evaluation phone call have on subjects benefiting from the VigilanS device? The participants will be divided into 2 groups: 1st group: SMS sent 48 hours before the 3-month evaluation call planned in the framework of the "VigilanS Lorraine" program. 2nd group (control): evaluation call at 3 months planned within the framework of the "VigilanS Lorraine" system, not preceded by an SMS 48 hours before. The desired effect was an increase in the percentage of successful calls at 3 months, allowing for possible evaluations at 3 months in order to identify, evaluate and accompany subjects still in a suicidal crisis and thus avoid a recurrence of the act and thus a suicide.

The primary aim of this project are to evaluate a comprehensive, practice-ready, and deployment-focused strategy for improving the prediction and prevention of suicide attempts among a sample of 4,000 patients presenting to an ED with a psychiatric concern. Our first aim is to evaluate the effects of providing information about risk of patient suicidal behavior to ED clinicians. We hypothesize that patients randomly assigned to have their clinician receive their risk score will have a lower rate of suicide attempts during 6-month follow-up and that this effect will be mediated by changes in clinician decision-making.

A new approach to investigate suicidal processes belongs to the broader neurocognitive picture and are so-called implicit associations. In dual process models of information processing a second functioning mode, the automatic processing mode, complements the conscious processing. Suicidal persons tend to have a stronger implicit association with "death" than non-suicidal persons. In this study, implicit associations between different unconscious cognitive constructs are compared among suicidal and non-suicidal patients. Therefore, an adapted version of the computer-based reaction time task (IAT-S) will be used. Four different versions of IATs are tested in this study. In the first version the implicit association between "self / others" and "death / life" is assessed (1). The second and third version measures the emotional evaluation of "death" (2) and "life" (3). In addition, in the fourth version the implicit association between death / life and internal / external locus of control is assessed (4). The implicit associations of these four IAT-S versions are compared between three groups: patients with suicidal behavior, patients with suicidal ideation, and a clinical group without previous suicide attempts and without suicidal ideation. The following hypotheses are made: in all four versions of the IAT-S, patients with previous suicidal behavior will have stronger implicit associations: between "self" and "death" as well as "death" and "internal locus of control" compared to all other groups. With a more "positive" evaluation of "death" and a more "negative" evaluation of "life" than all other participants.

Several studies agree on the increase in suicide attempts in children over the past 15 years. This trend has been aggravated by the COVID 19 pandemic. It is recognized that suicide attempts are mostly encountered in individuals with a psychiatric disorder. Serious suicide attempts, which probably better reflect the risk of completed suicide, are very poorly known and have been very little explored. They could be related to more specific and earlier psychiatric disorders or even concern children with developmental particularities that are insufficiently defined to fall under a categorical diagnosis, but which could be better understood with dimensional measurements. Better characterizing them would seem quite important given their high lethality. Indeed, a high lethality is found for half of the suicide attempts in children fewer than 12, contrasting with a moderate or low intentionality ; in children, the means used are often more violent and more lethal than in adolescents (over 12 years old): hanging, firearm, etc. The Necker-Enfants Malades hospital has a pediatric neurosurgery department as well as a specialized multidisciplinary team to care for polytraumatized children in a regional "Trauma Center" type structure. As a result, most children and adolescents in Ile-de-France who have made a violent suicide attempt are sent to the Necker hospital. Once medico-surgically stabilized, these children and adolescents are assessed by the hospital's child psychiatry team. This regional recruitment makes it possible to have an epidemiological representativeness. From this population, the investigative team proposes to better characterize the developmental profile and psychiatric disorders of children who have made a serious suicide attempt. The study also proposes to examine in detail the psycho-emotional development as well as the psychopathological characteristics of these children in order to shed light on these early and lethal acting out. The investigative team proposes in particular to use dimensional evaluations to analyze behavioral traits in more detail. To the knowledge of the child psychiatry department of the Necker Enfants Malades hospital, there is no such study to date.

Suicide is a major public health problem. About 9,000 suicides per year are retrieved by year in France. Between 15,000 and 20,0000 suicide attempts give rise to contact with the healthcare system. Among young people aged 15 to 24 years old, suicide is the second main cause of death. In this way, suicide among adolescents is a major public health priority, due to its seriousness, its frequency, and its potentially preventable nature. The severity of suicide risk can be assessed by different scales, and the Columbia-Suicide Severity Rating Scale (C-SSRS) is the most widely used in the international literature for adolescents, assessing four dimensions: suicidal ideation, severity of ideation, suicidal behavior and lethality. The measurement of the seriousness of the suicide risk is therefore defined as the measurement of the importance of the direct and indirect negative consequences associated with this risk. It can be catch up in the four factors mentioned above. Anxiety is one of the central pillars influencing the suicidal risk of adolescents. Very few studies have identified operationalizable and generalizable risk factors for anxiety. However, in adolescents, one of the risk factors for anxiety seems particularly important, because it is a factor that is both generic (i.e., it can be found in different profiles of adolescents), related to the projection in the future (which characterizes this population), and relatively specific to this age group, while being operational through validated questionnaires. This important risk factor is the eco-anxiety, which corresponds to anxiety related to climate change. The theme of climate change is certainly a central social issue, but also an important public health issue. First, climate change raises direct risks to human health, and indirectly some risks for mental health. For instance, the direct consequences of a drought or natural disaster can cause material hardship that impacts indirectly mental health (Thoma et al., 2021). Secondly, climate change can also raise direct risk for mental health, and especially the eco-anxiety which is not the consequence of a direct risk from the environment on an individual, but rather constitutes mental distress related to the fear of such changes. Eco-anxiety can be identified and measured in a valid and reliable way thanks to a scale used in the international literature, the "Climate Anxiety Scale" (CAS), which was validated in 2020 with 22 items with 4 factors by Clayton and Karazsia (Clayton and Karazsia, 2020), and translated and validated in French in 2022 by Mouguiama-Daouda (Mouguiama-Daouda et al., 2022), retaining as the most appropriate model the version with the first 13 items. This scale is suitable for adolescents from the age of 12 years old. This 13-item scale is composed of two subscales that assess cognitive and emotional difficulties in response to climate change and functional impairment. Two subscales are added to this 13-item scale (and thus are part of the 22-item CAS also validated), which assess 1) direct or indirect personal experience of climate change, and 2) behavioral commitment and the tendency to deploy adaptive behavioral responses to climate change. The literature reports a correlation between eco-anxiety and depression (Mouguiama-Daouda et al., 2022). Indeed, depressive symptoms can influence how people worry about climate change. The correlation between eco-anxiety and anxiety is variable in the literature and has been studied using questionnaires focusing on generalized anxiety (Mouguiama-Daouda et al., 2022). Higher suicide rates have certainly been shown in populations affected by climate change (Dumont et al., 2020), related to the direct consequences of climate change, e.g., due to pollution, increased temperature or drought. However, to the knowledge of the investigators and despite the major public health impact in adolescents, no study has investigated the relationships between eco-anxiety and the severity of suicide risk. This study therefore seeks to examine the association between eco-anxiety in adolescents, assessed using the French version of the CAS, and the severity of suicide risk, assessed using the French version of the C-SSRS. We hypothesize that there would be a relationship between eco-anxiety and the severity of suicide risk in adolescents. Such results would allow both to refine the understanding of the risk of suicide, in its relationship with a central theme of society and public health, and to better identify and prevent behaviors at risk of suicide among adolescents.

Open enrollment study to collect data for the optimization of machine learning models for use in an app for the early detection of mental health and suicidal risk.

Suicide accounts for at least 1 million deaths globally each year. This is likely a significant underestimate, because suicide is under-reported in many countries. In the US, over 42,000 people die from suicide annually. Despite increased focus on identification and treatment, the rate of suicide has increased steadily over the past 15 years. Our project aims both to improve our understanding of factors that increase the risk for suicide by comparing blood biomarkers associated with inflammation in patients with depression without suicidal behavior and patients with depression and suicidal behavior. The 160 individuals in this study will be followed with psychiatric assessments and blood samples at repeated time points over one year.

The study authors hypothesize a combination of cognitive, brain structural, brain functional and brain connectivity impairments in Suicide Attempters compared to Patient Controls and Healthy Controls, with deficits more marked in suicide attempters using violent suicidal means including: Impaired choices at the reversal learning task with responses influenced by immediate outcome. This deficit would be correlated with brain activity in ventromedial Prefrontal Cortex during resting state and with several peripheral markers of the 5HT-system. Reduced loss aversion. These deficits would be related to altered dynamics of Blood-Oxygen Level Dependent signal in the dorsal and ventral striatum as well as in ventral Prefrontal Cortex/ orbitofrontal cortex during the loss aversion task. These deficits would also be correlated with several peripheral markers of the 5HT-system. Increased pain tolerance facilitating the execution of a violent and possibly painful act. These deficits measured with the algometer would be correlated with several peripheral markers of the 5HT-system. Reduced behavioral inhibition in aversive context at the orthogonalized GoNoGo task facilitating the choice of a violent means. These deficits would be associated with altered Blood-Oxygen Level Dependent signal in ventral Prefrontal Cortex/ orbitofrontal cortex and parietal cortex during the resting state and correlated with several peripheral markers of the 5HT-system.

Suicidal behaviors seriously alter the vital and functional prognosis of adolescents. Although the literature has lighted out a considerable number of risk factors for suicide attempts in youth, theoretical models - among which bio-psycho-social models - still lack empirical evidence. More specifically, the way adverse life events dynamically interact together and with the individual's diathesis to precipitate suicidal attempts remains unclear. Studies of life trajectories have opened an alternative approach to traditional linear epidemiological analysis to capture such a complex process. To date, adverse trajectories approaches never have been applied to the period immediately preceding the occurrence of the suicidal gesture (proximal adverse trajectories).