Sodium nitrite (SN, NaNO2) is a water-soluble, white-yellow crystalline powder with broad applications in food preservation, automotive maintenance, and animal control. It is a strong oxidizing agent that can oxidize hemoglobin iron (Fe) to its oxidized state, leading to methemoglobin formation. An increasing trend of suicide cases by SN ingestion has been reported globally following its popularization in online suicide forums providing detailed instructions of its use solely or as part of a “suicide kit.” We report a case of a 21-year-old male who was found continuously vomiting, with blood per orem and cyanosis of the mouth and digits. Within minutes of the onset of symptoms, the patient lost consciousness and was pronounced dead on arrival at the nearest emergency room. Autopsy findings showed lip erosions, hemorrhage, and perioral and peripheral cyanosis. Internal examination showed characteristic bright red muscle discoloration, dark brown arterial blood, red-brown congested visceral organs, and hyperemic esophageal and gastric mucosa. Methemoglobin studies from sampled arterial blood showed elevated levels (17.5%). Further investigation of the decedent’s belongings, social media posts, and recent online purchases reinforced the intentional sodium nitrite ingestion. While there are plenty of reported SN poisoning in suicide cases internationally, limited reports have been published locally. Death by SN poisoning is preventable with Methylene blue. The role of forensic pathologists through autopsy may be the last chance to detect such cases. The lack of systemic death investigation, experts, and local laboratories to reliably detect the signs of SN poisoning may have affected the low detection rate of cases locally. Further reporting of cases can raise the awareness of medical professionals that is fundamental to the ultimate saving of lives.

Background: Suicide among adolescents is a critical global health problem. Identifying risk factors for suicide in adolescents is crucial because it is one of the most severe mental health issues and can result in loss of life. Risk factors serve as indicators that have the potential to bring life to an end. However, people around adolescents often display indifference and even tend to overlook the suicide risk factors experienced by them. Objective: This study aimed to explore the risk factors for suicide in adolescents in Indonesia. Methods: This study used qualitative descriptive research design conducted at State Vocational High Schools (SMKN) and Puskesmas. Data collection was done through Focus Group Discussion (FGD) of 10 students, and in-depth interviews of eight participants (two parents of adolescents who attempted suicide, two guidance counseling teachers, two adolescents who attempted suicide, and two mental nurses) The data were analyzed using thematic analysis. Results: The risk factors for suicide experienced by adolescents are biological, psychological, and social factors. These risk factors for suicide are stressors that contribute to adolescents engaging in suicidal behavior. Identifying the risk factors experienced by adolescents is crucial for suicide prevention. Conclusion The risk factors that lead to suicide in adolescents encompass biological, psychological, and social factors. A thorough understanding of suicide among parents, teachers, and peers can significantly assist in implementing suitable prevention measures and interventions for adolescent suicide.
Adolescent ; Risk Factors ; Biological Factors ; Psychology ; Social Factors ; Suicide

Non-suicidal self-injury (NSSI) is becoming increasingly common in adolescents and seriously affects their physical and mental health, and it is also a major risk factor for suicide among adolescents. NSSI has now become a public health issue of general concern; however, the identification of cognitive dysfunction in NSSI is still based on neuropsychological cognitive assessment and subjective questionnaire assessment, with a lack of objective evaluation indicators. As a method for studying the cognitive neural mechanism of NSSI, electroencephalography is a reliable tool for finding objective biomarkers of NSSI. This article reviews the recent research on electrophysiology associated with cognitive dysfunction in adolescents with NSSI.
Humans ; Adolescent ; Self-Injurious Behavior ; Cognitive Dysfunction ; Electroencephalography ; Neuropsychological Tests ; Risk Factors

This paper summarizes a lecture on psychiatry and spirituality, which examined research onthe relationship between religion, spirituality and mental health, and discussed theimportance of addressing spiritual issues in psychotherapy. In this article, religion andspirituality are first differentiated from one another. Next, research on the relationshipbetween religion and mental health is examined. Third, a theoretical model is presentedexplaining how religious involvement may affect mental and social health. Fourth, a review of religious/spiritually-integrated psychotherapy is presented with a focus ondepression/anxiety, moral injury, and PTSD. Finally, further resources for more informationabout the topic is provided. Because many people in the Philippines are religious, and religionaffects mental health one way or the other, it cannot be ignored by psychiatrists who practicein this country.
Religion ; Spirituality ; Depression ; Anxiety ; Suicide ; Substance-Related Disorders ; Stress Disorders, Post-Traumatic ; Psychotherapy

Objectives: In the light of increased suicide risk among adolescents, this research aimed at determining the prevalence and severity of suicidal ideations and behaviors of senior high school students in a public secondary school in Metro Manila using the Columbia-Suicide Severity Rating Scale (C-SSRS). Methodology: This is a descriptive cross-sectional school-based study, conducted on 236 senior high school students, 18 years old and above, in San Juan National High School (SJNHS) in San Juan, Metro Manila. The study employed convenience sampling. Upon selection, the C-SSRS was administered. Data on four constructs of suicide were gathered: 1) suicidal ideation severity; 2) intensity, which was quantified in terms of frequency, duration, control, deterrents and reasons for suicidal ideation; 3) suicidal behavior rated on a nominal subscale as actual, aborted, interrupted, preparatory behavior and non-suicidal injurious behavior; and lastly 4) lethality of actual suicide attempts on a 6-point ordinal scale, and if actual lethality was zero, potential lethality was further rated on a 3-point ordinal scale. Results: The majority (67.8%) had mild suicidal ideations; 37.71% had active suicidal ideations with intent but not necessarily a specific plan and only 13.98% had active suicidal ideation with intent to act and a specific plan. The intensity of suicidal ideation was not that frequent in 35.59% of the respondents i.e.18.64% 1x/ week and 16.95% less than 1x/ week. About a third (30.07%) had very short duration of suicidal ideations i.e. fleetingly (19.92%) or less than an hour/ day (11.02%). A third (32.62%) were able to easily control (18.64%) or control with minimal difficulty (13.98%). Reason for suicidal ideation were either to get attention (10.59%) or to end the emotional pain (11.02%). A third (30.93%) had actual attempts (15.25%) and Non -Suicidal Self Injury (NSSI) (15.68%); while another 35.06 % had interrupted (16.53%) or aborted (19.07%) attempts. Those who had actual attempts, 41.67% had no physical injury while 50 % incurred minor injuries. Thirty- two (88.89%) had suicidal attempt that was likely to result in injury but not likely to cause death. Conclusion In light of these relatively high prevalence rates for suicidal ideation and behaviors, schoolwide intervention on education or awareness programs, gatekeeper training, peer leadership, skills training and screening or assessment may have to be instituted to curb the increased suicide risk of the senior high school students and further prevent suicide attempts.
Prevalence ; Suicidal Ideation

BACKGROUND: There has been minimal research on the role of benevolent childhood experiences (BCEs) and how such events may offer protection from the insidious effects of adverse childhood experiences (ACEs) or later in life. OBJECTIVES: This research aims to learn how BCEs and ACEs interact to affect adolescents' psychological distress. METHODS: Cross-sectional survey was conducted in three cities (Xuzhou, Nanjing, and Wuhan) in China from March 2021 to May 2021. Latent class analysis (LCA) was used to classify the patterns of ACEs and BCEs. We adopted hierarchical multivariable regression to examine the influences of ACEs and BCEs on depression and suicidal ideation. RESULTS: To explore the relationship between childhood experience and suicidal ideation and depression, LCA revealed three patterns of ACEs: (1) emotional abuse (10.57%); (2) high ACEs (0.55%); and (3) low ACEs classes (88.88%). Adolescents with emotional abuse (depression: OR = 3.82, 95%CI = 2.80-5.22, P < 0.001; suicidal ideation: OR = 5.766, 95%CI = 3.97-8.38, P < 0.001) and high ACEs class (suicidal ideation: OR = 5.93, 95%CI = 1.19-29.66, P < 0.05) had an increased risk of psychological distress (reference: low ACEs). LCA revealed four patterns of BCEs: (1) relationship support (14.54%); (2) low BCEs (4.85%); (3) high BCEs (55.34%); and (4) high quality of life classes (25.28%). Adolescents with a high quality of life (depression: OR = 0.09, 95%CI = 0.05-0.16, P < 0.001; suicidal ideation: OR = 0.22, 95%CI = 0.12-0.40, P < 0.001) and high BCEs (depression: OR = 0.05, 95%CI = 0.03-0.09, P < 0.001; suicidal ideation: OR = 0.15, 95%CI = 0.09-0.26, P < 0.001) protected the mental health of adolescents (reference: low BCEs). CONCLUSIONS High ACEs and emotional abuse classes were significantly associated with poorer mental health symptoms, including suicidal ideation and depression. In contrast, high BCEs and high quality of life classes were associated with better mental health. These findings point out that it is more necessary to identify and support victims of ACEs, and it is urgent to increase BCEs in early childhood.
Adolescent ; Humans ; Cross-Sectional Studies ; Depression ; East Asian People ; Latent Class Analysis ; Quality of Life ; Suicidal Ideation ; Adverse Childhood Experiences

OBJECTIVES: To explore the characteristics of postmortem examination, chemical examination and scene investigation of deaths caused by oral diphenidol hydrochloride poisoning, and so as to provide a reference for proper settlement and prevention of such deaths. METHODS: The data of 22 deaths caused by oral diphenidol hydrochloride poisoning in a city from January 2018 to August 2020 were collected, including case details, scene investigations, autopsies, chemical examinations and digital evidence. Thirty-one cases of deaths caused by oral diphenidol hydrochloride poisoning reported in previous literature were also collected. RESULTS: In the 53 oral diphenidol hydrochloride poisoning death cases, 50 cases were suicide, 2 cases were accidental, while 1 case was undetermined. Fifty-two cases were found in the medical records or crime scene investigation reports with doses ranging from 775 mg to 12 500 mg, and 23 deceased were detected with postmortem blood concentrations ranging from 2.71 mg/L to 83.1 mg/L. Clinical symptoms were recorded in 6 patients, including conscious disturbance and convulsion. Among the 45 cases which were performed with external examination, 23 cases autopsied. CONCLUSIONS Most of the deceased of oral diphenidol hydrochloride poisoning were suicide. No significant correlation was found between dose and blood concentration through the retrospective analysis of cases.
Humans ; Retrospective Studies ; Piperidines ; Autopsy ; Suicide ; Poisoning

OBJECTIVE: To present an approach to phenotyping ACEs and explore the association between ACEs and adolescent health risky behaviors based on the social context of China. METHODS: Totally, 5,726 adolescents aged 12-18 years were investigated about their ACEs in the family, peer, school, and personal domains and the occurrence of six types of risky health behaviors (i.e., smoking, drinking, sexual intercourse, self-harm, and suicidal ideation and attempts). Latent class analysis (LCA) was used to explore the ACE patterns. RESULTS: Six latent classes of ACEs were identified, including low adversity, school adversity, school adversity and peer victimization, peer victimization, maltreatment and peer victimization, and high adversity, and associated with risky health behaviors in adolescents. Being physically punished by a teacher, experiencing sexual abuse, and experiencing family trauma most strongly differentiated from the six ACE classes and were correlated with an increased risk for risky adolescent health behaviors. CONCLUSION This study supports a positive association between ACEs and risky adolescent health behaviors. Peer victimization, school adversity and associated contexts need to be considered in future ACE studies.
Adverse Childhood Experiences ; Health Risk Behaviors ; Humans ; Phenotype ; Self-Injurious Behavior/epidemiology*

Objective: To investigate the prevalence of suicidal ideation among MSM, and to explore the influence of perceived social support and depression on suicidal ideation and the possible pathway. Methods: MSM who are ≥18 years, HIV-negative, and ever had sex with men (oral sex/anal sex) in the last year participated in is study. Cross-sectional survey and convenient sampling method were used to recruit MSM through a male social interaction platform Blued 7.5 software from December 2020 to March 2021, with a questionnaire survey. Demographic questionnaire, Perceived Social Support Questionnaire and Center for Epidemiologic Studies Depression Scale were employed to collect data. Mplus 8.3 was used for data analysis. Results: Among 1 394 eligible MSM participants, 25.7% (358/1 394) had suicidal ideation. Perceived social support could have a direct effect on suicidal ideation (β=-0.11, P=0.009), and an indirect effect on suicidal ideation through depression (β=-0.18, P<0.001). Conclusions: Suicidal ideation was found to be lower in MSM with a higher level of perceived social support and a lower level of depression. Using social media to improve MSM's perceived social support and reduce depressive symptoms might be an effective means to prevent suicidal ideation.
Cross-Sectional Studies ; Depression/epidemiology* ; Homosexuality, Male ; Humans ; Male ; Sexual Behavior ; Sexual and Gender Minorities ; Social Support ; Suicidal Ideation

Objective: To analyze the prevalence and related factors of suicide ideation among nurses in different levels of hospitals in Shandong Province, and to analyze the relationship between them. Methods: From June to July 2020, 1644 nurses in Shandong Province were surveyed by multi-stage stratified cluster sampling. The suicidal ideation of nurses was investigated by suicidal ideation screening. Social support and mental health were measured by the perceived social support scale (pass) and kessler10 scale respectively. The simple coping style scale (SCSQ) was used to evaluate the coping styles of the subjects when they encountered problems. Logistic regression was used to analyze the influencing factors of suicidal ideation, Amos software was used to establish the path model of suicidal ideation related factors, and the maximum likelihood estimation was used to test the path model coefficient. Results: The incidence of suicidal ideation among nurses in secondary hospitals during their career was 8.44%, and that in tertiary hospitals was 11.66%. There was no significant difference in suicidal ideation among nurses at all levels in secondary hospitals (P>0.05) . The main factors related to suicidal ideation were unmarried and others (OR=0.362, 95%CI=0.155, 0.844, P=0.019) , social support (OR=1.084, 95% CI=1.059, 1.109, P=0.000) and mental health status (OR=0.921, 95% CI=0.890, 0.953, P=0.000) . The suicide ideation of skilled nurses in tertiary hospitals was higher than that of other levels (P<0.05) . The related factors of suicide ideation mainly included unmarried and others (OR=0.369, 95% CI=0.214, 0.636, P=0.000) , night shift (OR=1.889, 95%CI=10.57, 3.377, P=0.032) , general self-rated social status (OR=2.377, 95%CI=1.031, 5.483, P=0.042) , physical disease (OR=2.747, 95%CI=1.601, 4.714) , P=0.000) , Social support (OR=0.960, 95%CI=1.042, 1.077, P=0.000) and mental health status (OR=0.942, 95%CI=0.922, 0.963, P=0.000) . Social support and mental health have a direct effect on suicidal ideation. Self-assessment of social status, social support and physical disease can affect suicidal ideation by affecting mental health. Conclusion: It is necessary to pay more attention to the mental health status of nurses at different levels in different hospitals during their career, improve their social support level, and improve their cognition of the practice environment.
Hospitals ; Humans ; Mental Health ; Nursing Staff ; Risk Factors ; Social Support ; Suicidal Ideation