Abstract This article aims to examine differences in suicidal narrative and suicide crisis syndrome symptoms, and suicidal ideation among those who maintained, lost, and gained employment or student status during the COVID-19 pandemic. It is a cross-sectional study based on an online and anonymous self-report questionnaire. Participants were recruited through social media platforms between November 2020 and October 2021. Changes in occupational status were assessed in 2,259 individuals. The sample was divided into four groups according to work (full-time/part-time) and study status (1) maintained, (2) lost, (3) gained, and (4) unemployed. Suicide outcomes were investigated by the Suicidal Narrative Inventory, Suicide Crisis Inventory, and Columbia - Suicide Severity Rating Scale Screener version. Changes in occupational status influenced symptoms of the suicide crisis syndrome and suicidal narrative, but not suicidal ideation. Those who maintained their work, such as full-time/part-time scored lower on the total scores of the Suicidal Narrative Inventory and Suicide Crisis Inventory-2 compared to those who lost their employed status and unemployed. Our findings suggest that it is appropriate to consider changes in employed status as a mental health risk factor during pandemics.

Resumo O objetivo do artigo é examinar diferenças nos sintomas da narrativa suicida e da síndrome de crise de suicídio e ideação suicida entre aqueles que mantiveram, perderam e ganharam emprego ou status educacional durante a pandemia de COVID-19. Trata-se de um estudo transversal baseado em um questionário online. Os indivíduos foram recrutados por meio de plataformas de mídia social entre novembro de 2020 e outubro de 2021. As mudanças no status ocupacional foram avaliadas em 2.259 indivíduos. A amostra foi dividida em grupos de acordo com as mudanças do status ocupacional: (1) aqueles que mantiveram, (2) aqueles que perderam, (3) aqueles que ganharam e (4) desempregados. Desfechos suicidas foram avaliados através do Inventário da Narrativa Suicida, Inventário da Crise Suicida e Columbia - Escala de Classificação da Gravidade do Suicídio. Mudanças no status ocupacional influenciaram sintomas da síndrome de crise de suicídio e narrativa suicida, mas não a ideação suicida. Aqueles que mantiveram seu emprego apresentaram menos sintomas de narrativa suicida e síndrome de crise de suicídio, comparados aos que perderam o emprego e aos desempregados. Esses achados sugerem que é apropriado considerar mudanças no status ocupacional como fator de risco para saúde mental durante pandemias.

Resumo O objetivo do artigo é examinar diferenças nos sintomas da narrativa suicida e da síndrome de crise de suicídio e ideação suicida entre aqueles que mantiveram, perderam e ganharam emprego ou status educacional durante a pandemia de COVID-19. Trata-se de um estudo transversal baseado em um questionário online. Os indivíduos foram recrutados por meio de plataformas de mídia social entre novembro de 2020 e outubro de 2021. As mudanças no status ocupacional foram avaliadas em 2.259 indivíduos. A amostra foi dividida em grupos de acordo com as mudanças do status ocupacional: (1) aqueles que mantiveram, (2) aqueles que perderam, (3) aqueles que ganharam e (4) desempregados. Desfechos suicidas foram avaliados através do Inventário da Narrativa Suicida, Inventário da Crise Suicida e Columbia - Escala de Classificação da Gravidade do Suicídio. Mudanças no status ocupacional influenciaram sintomas da síndrome de crise de suicídio e narrativa suicida, mas não a ideação suicida. Aqueles que mantiveram seu emprego apresentaram menos sintomas de narrativa suicida e síndrome de crise de suicídio, comparados aos que perderam o emprego e aos desempregados. Esses achados sugerem que é apropriado considerar mudanças no status ocupacional como fator de risco para saúde mental durante pandemias. COVID19. COVID19 COVID 19. 19 COVID-19 Tratase Trata se online 202 2021 2259 2 259 2.25 1 (1 (2 3 (3 4 (4 desempregados Suicídio pandemias COVID1 COVID-1 20 225 25 2.2 ( COVID- 22 2.

Abstract This article aims to examine differences in suicidal narrative and suicide crisis syndrome symptoms, and suicidal ideation among those who maintained, lost, and gained employment or student status during the COVID-19 pandemic. It is a cross-sectional study based on an online and anonymous self-report questionnaire. Participants were recruited through social media platforms between November 2020 and October 2021. Changes in occupational status were assessed in 2,259 individuals. The sample was divided into four groups according to work (full-time/part-time) and study status (1) maintained, (2) lost, (3) gained, and (4) unemployed. Suicide outcomes were investigated by the Suicidal Narrative Inventory, Suicide Crisis Inventory, and Columbia - Suicide Severity Rating Scale Screener version. Changes in occupational status influenced symptoms of the suicide crisis syndrome and suicidal narrative, but not suicidal ideation. Those who maintained their work, such as full-time/part-time scored lower on the total scores of the Suicidal Narrative Inventory and Suicide Crisis Inventory-2 compared to those who lost their employed status and unemployed. Our findings suggest that it is appropriate to consider changes in employed status as a mental health risk factor during pandemics. COVID19 COVID 19 COVID-1 pandemic crosssectional cross sectional selfreport self report questionnaire 202 2021 2259 2 259 2,25 individuals fulltime/parttime fulltimeparttime full time/part time part (full-time/part-time 1 (1 (2 3 (3 4 (4 unemployed version Inventory2 Inventory- pandemics COVID1 COVID- 20 225 25 2,2 fulltime parttime timepart ( 22 2,

Abstract Comparing one’s appearance to other people’s and believing in an ideal body shape can negatively impact an individual. The probability of developing ED in individuals with high body dissatisfaction is higher than in the general population, leading to long-term emotional and metabolic damage. Populational studies on the prevalence of ED in Brazil are scarce in the literature. The research was carried out through the Google Forms website and evaluated risk of eating disorders through the Eating Attitude Test, degree of body dissatisfaction in the sample through the Body Shape Questionnaire and the Internet Addiction Test was used to evaluate time spent on the internet. The results showed that 84.5% of the sample were female and 62.3% of the individuals had eutrophic by the Body Mass Index. About 40.2% of the population studied had abnormal attitudes towards food, indicating a possible risk of developing ED, and 62.5% of the sample did not show body dissatisfaction. Regarding internet use, 10.8% had problematic internet use. The presence of risky eating attitudes was more prevalent in participants dissatisfied with their bodies. In addition, participants with problematic internet use had a higher risk for EDs. ones one s peoples people individual longterm long term damage literature 845 84 5 84.5 623 62 3 62.3 Index 402 40 2 40.2 food 625 62.5 108 10 8 10.8 bodies addition EDs 84. 6 62. 4 40. 1 10.

Objective: To evaluate the factor structure, reliability, and validity of the Brazilian version of the Suicide Crisis Inventory-2 (SCI-2) among Brazilian adults. Methods: The SCI-2 was cross-culturally adapted into Portuguese and administered to 2,265 Brazilian participants. Confirmatory factor analysis (CFA) was used to assess factor structure, internal consistency, convergent validity, and criterion validity by using measures such as suicidal narratives, stressful life events, suicidal ideation, and suicide attempts. Results: The revised one-factor model of the SCI-2 demonstrated an adequate, although not optimal, model fit (χ2[1539] = 31,442.79, p < 0.001, comparative fit index [CFI] = 0.99, Tucker-Lewis index [TLI] = 0.99, root mean square error of approximation [RMSEA] = 0.09, standardized root mean residual [SRMR] = 0.05). The revised five-factor model, on the other hand, demonstrated good fit (χ2[1529] = 14,174.86, p < 0.001, CFI = 1.00, TLI = 1.00, RMSEA = 0.06, SRMR = 0.04). Comparison of these two models indicated that the five-factor model had a better fit than the one-factor model. Both the total and subscale scores of the SCI-2 showed strong internal consistency and good convergent and criterion validity in relation to stressful life events, suicidal narratives (excluding the goal disengagement subscale), suicidal ideation, and suicide attempts. Conclusion: Our findings suggest that the Brazilian version of the SCI-2 is a valid tool for assessing symptoms of suicidal crisis syndrome. Objective structure reliability Inventory2 Inventory 2 Inventory- SCI2 SCI (SCI-2 adults Methods SCI- crossculturally cross culturally 2265 265 2,26 participants CFA (CFA events ideation attempts Results onefactor one adequate optimal χ21539 χ χ2 1539 (χ2[1539 3144279 31 442 79 31,442.79 0001 0 001 0.001 [CFI 099 99 0.99 TuckerLewis Tucker Lewis [TLI [RMSEA 009 09 0.09 [SRMR 0.05. 005 0.05 . 05 0.05) fivefactor five hand χ21529 1529 (χ2[1529 1417486 14 174 86 14,174.86 100 1 00 1.00 006 06 0.06 0.04. 004 0.04 04 0.04) excluding subscale, , subscale) Conclusion syndrome (SCI- 226 26 2,2 χ2153 153 (χ2[153 314427 3 44 7 31,442.7 000 0.00 9 0.9 0.0 χ2152 152 (χ2[152 141748 17 8 14,174.8 10 1.0 (SCI 22 2, χ215 15 (χ2[15 31442 4 31,442. 0. 14174 14,174. 1. χ21 (χ2[1 3144 31,442 1417 14,174 (χ2[ 314 31,44 141 14,17 (χ2 31,4 14,1 (χ 31, 14,

Objective: To test the factor structure, reliability, and validity of the Brazilian version of the Abbreviated Suicidal Narrative Inventory (SNI-38). Methods: We used an anonymous online questionnaire of the SNI-38 and self-report measures administered between November 2020 and October 2021 in the Brazilian community. Participants were recruited through social media advertisements. Confirmatory factor analysis (CFA) was performed to test the factor structure of the SNI-38. In addition, we assessed internal consistency and convergent validity against stressful life events, suicide crisis syndrome, suicidal ideation, and suicide attempts. Results: A total of 2,660 participants were included. The eight-factor model of the SNI-38 had a good model fit (χ2[637] = 7,473.98, p < 0.001, comparative fit index [CFI] = 0.99, Tucker-Lewis index [TLI] = 0.99, root mean squared error of approximation [RMSEA] = 0.07, standardized root mean residual [SRMR] = 0.06). Notably, all items were significantly and positively loaded onto their respective factors (factor loadings ≥ 0.45). The reliability of all subscales except for goal disengagement ranged from good to high. Furthermore, all subscales except goal disengagement showed positive correlations with variables such as suicide crisis syndrome, stressful life events, lifetime/past month suicidal ideation, and lifetime suicide attempts. Conclusion: These findings provide preliminary support for the validity of the Brazilian version of the SNI-38 as an appropriate, valid instrument for measuring suicidal narratives in Brazilian individuals. Objective SNI38. SNI38 SNI 38 . (SNI-38) Methods SNI-3 selfreport self report 202 community advertisements CFA (CFA 38. addition events syndrome ideation attempts Results 2660 2 660 2,66 included eightfactor eight χ2637 χ χ2 637 (χ2[637 747398 7 473 98 7,473.98 0001 0 001 0.001 CFI [CFI 099 99 0.99 TuckerLewis Tucker Lewis TLI [TLI RMSEA [RMSEA 007 07 0.07 SRMR [SRMR 0.06. 006 0.06 06 0.06) Notably 0.45. 045 0.45 45 0.45) high Furthermore lifetimepast past Conclusion appropriate individuals SNI3 3 (SNI-38 SNI- 20 266 66 2,6 χ263 63 (χ2[63 74739 47 9 7,473.9 000 00 0.00 09 0.9 0.0 04 0.4 4 (SNI-3 26 6 2, χ26 (χ2[6 7473 7,473. 0. (SNI- (χ2[ 747 7,473 (SNI (χ2 74 7,47 (χ 7,4 7,

Objectives: The kynurenine (KYN) pathway has been attracting attention as a relevant pathway in schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD). We conducted a systematic review and meta-analysis of studies examining KYN pathway metabolites from cerebrospinal fluid (CSF) samples in SZ, BD, and MDD. Methods: The PubMed and Scopus databases were systematically searched to identify peer-reviewed case-control studies published until April 2022 that assessed KYN metabolites, namely, tryptophan (TRP), KYN, kynurenic acid (KA), quinolinic acid (QA), and 3-hydroxykynurenine (3-HK), in subjects with SZ, BD, or MDD compared with healthy controls (HC). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The random effects model method was selected for comparison of standardized mean differences (SMD) between two groups. Results: Twenty-three articles met the inclusion criteria (k = 8, k = 8, k = 11, for SZ, BD, and MDD, respectively). In SZ, KA levels were increased (SMD = 2.64, confidence interval [CI] = 1.16 to 4.13, p = 0.0005, I2 = 96%, k = 6, n=384). TRP (k = 5) and KYN (k = 4) did not differ significantly. In BD, TRP levels (k = 7) did not differ significantly. The level of KA was increased in MDD (k = 2), but the small number of studies precluded evaluation of statistical significance. Finally, in MDD, although some studies tended to show an increased level of KYN in those with remission vs. decreased levels in those with current depression, no significant difference was found in any KYN metabolite levels. Similarly, an increased level of QA was found, but the number of studies (k = 2) was small. Conclusion: KA, which has possibly neuroprotective effects, is increased in SZ. QA, which has neurotoxic effects, may be increased in MDD. There were no alterations in BD. Alterations in the KYN pathway may occur based on population characteristics and mood states. Future studies should explore the utility of these metabolites as biomarkers. Objectives (KYN SZ , (SZ) BD (BD) . (MDD) metaanalysis meta analysis CSF (CSF Methods peerreviewed peer reviewed casecontrol case control 202 namely TRP, (TRP) (KA) (QA) 3hydroxykynurenine hydroxykynurenine 3 3HK, 3HK HK (3-HK) HC. HC (HC) MetaAnalyses Meta Analyses PRISMA (PRISMA followed SMD groups Results Twentythree Twenty three 8 11 respectively. respectively respectively) 264 2 64 2.64 CI [CI 116 1 16 1.1 413 4 13 4.13 00005 0 0005 0.0005 I 96 96% 6 n=384. n384 n n=384 384 n=384) 5 significantly 7 2, significance Finally vs depression Similarly Conclusion states biomarkers (SZ (BD (MDD 20 (TRP (KA (QA (3-HK (HC 26 2.6 1. 41 4.1 0000 000 0.000 9 n38 n=38 38 2. 4. 00 0.00 n3 n=3 0.0 n= 0.

Crisis hotlines are direct communication systems, usually telephone-based, set up to prevent suicide. However, few studies have evaluated their effectiveness. The present study aims to perform a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, of the effectiveness of interventions through direct communication systems to reduce the number of suicides or suicide attempts. We searched the MEDLINE, Cochrane, SciELO, and ClinicaTrials.gov databases, and used the 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence classification. The literature search yielded 267 studies, of which 35 fulfilled the selection criteria. Although significant heterogeneity was found among studies, there is evidence that direct telephone interventions are effective when included in broader preventive protocols and provided by trained staff. Despite the limitations, which included heterogeneity of samples, designs, and outcome measures, we were able to design a protocol for the use of remote services to prevent suicide and suicide attempts. A hotline or similar system could be an effective intervention for broader suicide prevention programs. However, further research is necessary to specify which protocol components are key to enhance effectiveness. Systematic review registry number: PROSPERO CRD42020206517 telephonebased, telephonebased based, based telephone-based However MetaAnalyses Meta Analyses PRISMA (PRISMA framework attempts MEDLINE Cochrane SciELO ClinicaTrialsgov ClinicaTrials gov databases 201 EvidenceBased Based classification 26 3 criteria staff limitations samples designs measures programs CRD CRD4202020651 20 2 CRD420202065 CRD42020206 CRD4202020 CRD420202 CRD42020 CRD4202 CRD420 CRD42 CRD4

Severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) causes the coronavirus disease 2019 (COVID-19), which has been declared a public health emergency of international interest, with confirmed cases in most countries. COVID-19 presents manifestations that can range from asymptomatic or mild infections up to severe manifestations that lead to hospitalization and death. A growing amount of evidence indicates that the virus may cause neuroinvasion. Postmortem brain study findings have included edema, hemorrhage, hydrocephalus, atrophy, encephalitis, infarcts, swollen axons, myelin loss, gliosis, neuronal satellitosis, hypoxic-ischemic damage, arteriolosclerosis, leptomeningeal inflammation, neuronal loss, and axon degeneration. In addition, the COVID-19 pandemic is causing dangerous effects on the mental health of the world population, some of which can be attributed to its social impact (social distancing, financial issues, and quarantine). There is also a concern that environmental stressors, enhanced by psychological factors, are contributing to the emergence of psychiatric outcomes during the pandemic. Although clinical studies and diagnosing SARS-CoV-2-related neurological disease can be challenging, they are necessary to help define the manifestations and burden of COVID-19 in neurological and psychiatric symptoms during and after the pandemic. This review aims to present the neurobiology of coronavirus and postmortem neuropathological hallmarks.

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517