Displaying publications 41 - 60 of 89 in total

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  1. Maniam T, L. F. Chan
    Sains Malaysiana, 2013;42:399-402.
    Suicide studies in Malaysia tend to be repetitive. Data from hospital studies, small scale community surveys and national epidemiological studies over nearly 50 years have consistently shown that there are real ethnic differences in terms of suicides and attempted suicides in this country, though some of these differences appear to be narrowing somewhat. Malays have shown significantly lower rates of suicidal ideas, attempts and completed suicides. Indians, on the other hand, figure prominently at the other end with high rates in all the above parameters. The reasons for these are also necessarily complex. Experience elsewhere from studies of the Indian diaspora have elucidated a number of explanations, which include the effects of poverty, acculturation, alcoholism, the lack of a strong religious protective factor as well as increased rates of mental ill-health. Efforts to contain this public health problem have been somewhat patchy. This has largely depended on efforts by non-government organizations such as the Befrienders whereas the public response
    lags behind in providing the financial and other resources necessary for a comprehensive national program. This paper reviews the relevant literature and suggest new areas for research as well as steps to provide a fresh impetus to suicide prevention in Malaysia.
    Matched MeSH terms: Suicidal Ideation
  2. Mak KK, Ho CS, Zhang MW, Day JR, Ho RC
    Asian J Psychiatr, 2013 Oct;6(5):373-9.
    PMID: 24011683 DOI: 10.1016/j.ajp.2013.03.011
    Overdosing is an accessible method adopted by people attempting suicide in city settings.
    Matched MeSH terms: Suicidal Ideation
  3. Lyndon N, Azman H, Che Rose RA, Mat Jali MF
    Clin Interv Aging, 2021;16:1379-1392.
    PMID: 34290500 DOI: 10.2147/CIA.S310405
    BACKGROUND: Globally, suicide is regarded as an immoral behavior and can be considered a criminal act in some societies. Sociological narrative views suicide not only as a result of mental illness suffered by the individuals but may also be caused by the social environment and other risk factors.

    PURPOSE: The objective of this study is to examine the social risk factors that drive older people to have suicidal feelings or tendencies and the extent to which these factors arise from the changes that occur in their social environment as a result of the process of modernization and industrialization.

    METHODS: This study employed the phenomenological approach through qualitative data collection technique. A total of 20 informants comprising 10 males and 10 females of Malay, Chinese and Indian ethnicity were selected for the study using purposive sampling technique. In-depth interviews were conducted with the informants. Data were transcribed and subsequently analyzed thematically using the NVivo 11 software.

    RESULTS: The findings revealed five conditions that led older people toward suicidal intentions. These include social and cultural changes, lack of social support, conflict in religious belief, influence of economic uncertainty and socio-economic status, and depression as a result of the changes in their social environment.

    CONCLUSION: The implication of this research is that these factors affect older people directly as they struggle to adapt and respond to the major changes that occur in the social structure of the society they live in, stemming from the process of modernization and industrialization. Efforts to enact better policies and services for older people need to be addressed especially in developing countries based on assessment of their needs, weaknesses, strengths, and capabilities by incorporating elements of the worldview of the older people based on their experiences of daily lives.

    Matched MeSH terms: Suicidal Ideation*
  4. Liew SH, Razak MAA, Kassim MSA, Ahmad NA, Tan L
    BMC Public Health, 2023 Nov 06;23(1):2165.
    PMID: 37932717 DOI: 10.1186/s12889-023-17019-2
    BACKGROUND: According to World Health Organization (WHO), the fourth leading cause of death among adolescents aged 15 -19 years is suicide. The National Health and Morbidity Survey (NHMS) 2017 reported that suicidal attempts among school adolescents increased from 6.8%-6.9% as compared to NHMS 2012. Suicide attempts can cause significant negative impacts on health, social and economic status. Bullying is one of the factors for adolescent suicide attempts, and its relationship to suicidality in adolescents has been shown in numerous research.

    OBJECTIVES: This study examined the relationship between suicide attempts and bullying among school adolescents in Malaysia.

    METHODS: Data from the Malaysia NHMS 2017, a nationwide study that adopted a two-stage cluster sampling design, were analysed. The survey used a self-administered questionnaire in bilingual language adapted from GSHS developed by WHO. Participants were secondary school students aged 13 -17 in all states. Descriptive and multiple logistic regression analyses were performed using IBM SPSS version 28.

    RESULTS: A total of 27,497 school adolescents participated in the study. Results showed that 6.9% of school adolescents had attempted suicide. There was 16.2% of adolescents being bullied. Multiple logistic regression revealed that students who were bullied were more likely to have suicide attempts (aOR 4.827, 95% CI: 4.143, 5.624) P 

    Matched MeSH terms: Suicidal Ideation
  5. Liang J, Kõlves K, Lew B, de Leo D, Yuan L, Abu Talib M, et al.
    Front Psychiatry, 2020;11:129.
    PMID: 32231596 DOI: 10.3389/fpsyt.2020.00129
    Background and Objective: Suicide is a leading cause of death in young people. Suicidal thoughts and behaviors can be triggered by life and study stresses; therefore, it is important to understand the role of coping strategies. The current study analyzed the link between different coping strategies and suicidality in university students in China. Methods: A cross-sectional study of 2,074 undergraduate students from China used a stratified-clustered-random sampling method (response rate 94.4%). The Suicidal Behaviors Questionnaire-Revised Scale was used to identify suicidal risks, while the Brief COPE scale was used to measure different coping strategies. Univariate and multivariate logistic regression analyses were utilized to examine coping strategies and suicidality. Results: A negative association of some coping skills (active coping and positive reframing) with suicidality and a positive association of some other coping skills (self-distraction, substance abuse, behavioral disengagement, venting, and self-blame) with suicidality were observed after adjusting for sociodemographic and mental health variables. Conclusions: Training and supporting young people to identify and apply adaptive coping strategies to deal with life stress could help to reduce suicidal ideation and behavior.
    Matched MeSH terms: Suicidal Ideation
  6. Lew B, Chistopolskaya K, Osman A, Huen JMY, Abu Talib M, Leung ANM
    BMC Psychiatry, 2020 02 18;20(1):73.
    PMID: 32070298 DOI: 10.1186/s12888-020-02485-4
    BACKGROUND: A substantial increase in rates of suicide worldwide, especially among late adolescents and young adults, has been observed. It is important to identify specific risk and protective factors for suicide-related behaviors among late adolescents and young adults. Identifying specific factors across the masses, not only in the Western, but also in the Asian context, helps researchers develop empirically informed intervention methods for the management of protective and risk factors of suicide.

    METHODS: In the current study, 2074 students (706 males), filled out the Meaning in Life Questionnaire, with subscales of Search for Meaning (MLQ-S) and Presence of Meaning (MLQ-P); the Future Disposition Inventory-24 (FDI-24), with subscales of Positive Focus (PF), Suicide Orientation (SO), and Negative Focus (NF); and the Beck Hopelessness Scale (BHS). These scales measure protective and risk factors that are linked to suicidal behaviors; while suicidal behaviors were measured by the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Mediation analyses were performed to test the models with both the MLQ-S and MLQ-P as the mediators between a) hopelessness, as measured by BHS and suicidal behaviors; and b) PF, SO, and NF, as measured by FDI-24, and suicidal behaviors.

    RESULTS: We found that only MLQ-P mediated the relation between hopelessness and suicidal behaviors; while both MLQ-P and MLQ-S mediated PF, SO, and NF (as measured by FDI-24), and suicidal behaviors, respectively.

    CONCLUSION: Meaning in life, including both the presence of meaning in life and search for meaning, can be good protective factors against suicidal behaviors.

    Matched MeSH terms: Suicidal Ideation*
  7. Lew B, Kõlves K, Osman A, Abu Talib M, Ibrahim N, Siau CS, et al.
    PLoS One, 2020;15(8):e0237329.
    PMID: 32822365 DOI: 10.1371/journal.pone.0237329
    BACKGROUND: Although the suicide rate in China has decreased over the past 20 years, there have been reports that the younger age group has been experiencing an increased incidence of completed suicide. Given that undergraduate groups are at higher risks of suicidality, it is important to monitor and screen for risk factors for suicidal ideation and behaviors to ensure their well-being.

    OBJECTIVE: To examine the risk and protective factors contributing to suicidality among undergraduate college students in seven provinces in China.

    METHODS: We conducted a cross-sectional study involving 13,387 college students from seven universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, Shaanxi, and Xinjiang. Data were collected using self-report questionnaires.

    RESULTS: Higher scores in the psychological strain, depression, anxiety, stress, and psychache (psychological risk factors for suicidality) and lower scores in self-esteem and purpose in life (psychological protective factors against suicidality) were associated with increased suicidality among undergraduate students in China. Demographic factors which were associated with higher risks of suicidality were female gender, younger age, bad academic results, were an only child, non-participation in school associations, and had an urban household registration. Perceived good health was protective against suicidality.

    CONCLUSIONS: Knowing the common risk and protective factors for suicidality among Chinese undergraduate students is useful in developing interventions targeted at this population and to guide public health policies on suicide in China.

    Matched MeSH terms: Suicidal Ideation*
  8. Lew B, Chistopolskaya K, Liu Y, Talib MA, Mitina O, Zhang J
    Crisis, 2020 Mar;41(2):82-88.
    PMID: 30935245 DOI: 10.1027/0227-5910/a000604
    Background: According to the strain theory of suicide, strains, resulting from conflicting and competing pressures in an individual's life, are hypothesized to precede suicide. But social support is an important factor that can mitigate strains and lessen their input in suicidal behavior. Aims: This study was designed to assess the moderating role of social support in the relation between strain and suicidality. Methods: A sample of 1,051 employees were recruited in Beijing, the capital of China, through an online survey. Moderation analysis was performed using SPSS PROCESS Macro. Social support was measured with the Multidimensional Scale of Perceived Social Support, and strains were assessed with the Psychological Strains Scale. Results: Psychological strains are a good predictor of suicidality, and social support, a basic need for each human being, moderates and decreases the effects of psychological strains on suicidality. Limitations: The cross-sectional survey limited the extent to which conclusions about causal relationships can be drawn. Furthermore, the results may not be generalized to the whole of China because of its diversity. Conclusion: Social support has a tendency to mitigate the effects of psychological strains on suicidality.
    Matched MeSH terms: Suicidal Ideation*
  9. Lew B, Huen J, Yu P, Yuan L, Wang DF, Ping F, et al.
    PLoS One, 2019;14(7):e0217372.
    PMID: 31260454 DOI: 10.1371/journal.pone.0217372
    Suicide is a major public health concern worldwide. This study aimed to predict the suicidal behavior of Chinese university students by studying psychological measures such as hopelessness, orientation to happiness, meaning in life, depression, anxiety, stress, and coping styles. In November 2016, a stratified-clustered-random sampling approach was utilized to select subjects from two large public medical-related universities in Shandong province, China. This sample consisted of 2,074 undergraduate students (706 males, 1,368 females; mean age = 19.79±1.39 years). The students' major risk factors for suicide were depression, anxiety, stress, and hopelessness, and the students' minor risk factors included orientation to happiness and coping styles (including self-distraction, self-blame and substance use). Notably, the presence of meaning in life had a positive effect on preventing suicide and acted as a protective factor, which suggests that it is important to identify risk factors as well as protective factors relevant to the target population group in order to increase the effectiveness of counseling and suicide prevention programs.
    Matched MeSH terms: Suicidal Ideation
  10. Lew B, Kõlves K, Zhang J, Zhizhong W, Koenig HG, Yip PSF, et al.
    PLoS One, 2021;16(5):e0251698.
    PMID: 34010317 DOI: 10.1371/journal.pone.0251698
    BACKGROUND: Several past studies indicated that religious beliefs, orientation, and practice are protective of suicide. Findings from recent studies in China suggest that religiosity may contribute to increased suicidality. However, few studies have examined the associations between religious affiliation across different faiths and suicidality in China.

    OBJECTIVE: The current study examines the association between religious affiliation and suicidality among college students in six provinces in China.

    METHODS: We conducted a cross-sectional study involving 11,407 college students from six universities in Ningxia, Shandong, Shanghai, Jilin, Qinghai, and Shaanxi. We collected the data between October 2017 and March 2018 using self-report questionnaires. They included self-report measures of depression, psychache, hopelessness, self-esteem, social support, and life purpose.

    RESULTS: Participants with a Christian affiliation had 1.5 times (95% CI: 1.14, 1.99, p = 0.004) higher odds of indicating an elevated suicide risk, 3.1 times (95% CI: 1.90, 5.04, p<0.001) higher odds of indicating a previous suicide attempt, and increased overall suicidality (B = 0.105, p < 0.001) after accounting for demographic and risk/protective factors. Christians also scored the highest in depression, psychache, hopelessness, and the lowest social support, self-esteem, and purpose in life. Muslims reported decreased suicidality (B = -0.034, p = 0.031). Buddhism/Daoism yielded non-significant results in the multivariate analyses.

    CONCLUSIONS: Christian college students reported increased suicidality levels, perhaps due to public policies on religion. The decreased suicidality levels among Muslims may be attributed to higher perceived social support. The associations between religious affiliation and suicidality, depression, and hopelessness contrast sharply with US samples. This finding may be influenced by interactions between the religious denomination, individual, and social/political factors. This conclusion includes the possibility of anti-religious discrimination, which this paper did not investigate as a possible mediator and therefore remains a conjecture worthy of future investigation.

    Matched MeSH terms: Suicidal Ideation*
  11. Lan Z, Pau K, Mohd Yusof H, Huang X
    Sci Rep, 2022 Oct 14;12(1):17238.
    PMID: 36241902 DOI: 10.1038/s41598-022-21377-z
    This study analyzed the factors influencing adolescents' non-suicidal self-injury (NSSI) behavior and their interrelationships, and established a total influencing factor model. Through a literature analysis and semi-structured interviews with 87 adolescents and 27 experts in Guangxi Province, China, 13 influencing factors were identified from six aspects: physiological factors, cognitive factors, emotional factors, social support factors, social environment, and NSSI behavior. A system of factors influencing adolescents' NSSI behavior and a model of the factors influencing the comprehensive antagonism multilevel explanatory structure were obtained using a combination of Decision-Making Trial and Evaluation Laboratory technique and Total Adversarial Interpretive Structural Model. In descending order, NSSI, emotional state, self-efficacy, and self-cognition influenced adolescents' NSSI behavior. Social environment, exercise, and recreation had a greater impact on other factors, while NSSI, emotional regulation ability, and emotional state were greatly affected by other factors. Emotion regulation ability, self-cognition, self-efficacy, family support, school support, social support, and sleep were found to be the core factors influencing NSSI behavior of adolescents. These factors could be used to directly intervene in adolescent NSSI behavior. Timely treatment of adolescents' negative emotional states is directly conducive to preventing NSSI behavior and alleviating its severity.
    Matched MeSH terms: Suicidal Ideation
  12. Khosravani V, Kamali Z, Jamaati Ardakani R, Samimi Ardestani M
    Psychiatry Res, 2017 09;255:139-145.
    PMID: 28549337 DOI: 10.1016/j.psychres.2017.05.032
    The aim of this study was to evaluate the relations of childhood trauma (CT) and obsessive-compulsive (OC) symptom dimensions to suicide ideation in patients with obsessive-compulsive disorder (OCD). Seventy OCD outpatients with lifetime suicide attempts and 60 controls were included. Participants completed the Scale for Suicide Ideation (SSI), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). Among OCD patients, 97.1% had current suicide ideation. OCD patients revealed higher scores on CT, suicide ideation, depression and anxiety than controls. The CT history of sexual abuse (SA) and OC symptom dimension of unacceptable thoughts explained suicide ideation. It was concluded that SA and unacceptable thoughts may contribute to high suicidality and have important implications for the assessment and treatment of suicide risk in OCD patients with lifetime suicide attempts.
    Matched MeSH terms: Suicidal Ideation*
  13. Khan A, Hamdan AR, Ahmad R, Mustaffa MS, Mahalle S
    Community Ment Health J, 2016 Feb;52(2):245-50.
    PMID: 26499062
    This study examined whether productive coping styles and social support were significant mediators of the relationship between academic stress and suicidal ideation. The survey was performed on a sample of 300 Malaysian and 300 Indian college students. The participants completed psychological assessments of productive coping styles, social support, academic stress, and suicidal ideation. Significant cultural and demographic differences emerged. Indian students reported higher suicidal ideation and academic stress than did Malaysian students, and Malaysian students received more social support and had better problem-solving coping styles than did Indian students. Overall, students who were male, non-religious, and from low-income families reported more academic stress and more suicidal ideation. Productive coping styles and overall social support strongly affected the relationship between academic stress and suicidal ideation among both countries' participants.
    Matched MeSH terms: Suicidal Ideation*
  14. Kalman JL, Yoshida T, Andlauer TFM, Schulte EC, Adorjan K, Alda M, et al.
    Eur Arch Psychiatry Clin Neurosci, 2022 Dec;272(8):1611-1620.
    PMID: 35146571 DOI: 10.1007/s00406-021-01366-5
    Personality traits influence risk for suicidal behavior. We examined phenotype- and genotype-level associations between the Big Five personality traits and suicidal ideation and attempt in major depressive, bipolar and schizoaffective disorder, and schizophrenia patients (N = 3012) using fixed- and random-effects inverse variance-weighted meta-analyses. Suicidal ideations were more likely to be reported by patients with higher neuroticism and lower extraversion phenotypic scores, but showed no significant association with polygenic load for these personality traits. Our findings provide new insights into the association between personality and suicidal behavior across mental illnesses and suggest that the genetic component of personality traits is unlikely to have strong causal effects on suicidal behavior.
    Matched MeSH terms: Suicidal Ideation*
  15. Jusnani, Embing
    MyJurnal
    One of the world's leading causes of death among teenagers aged 15-29 is suicide. Students of higher institutions also involved in the specific group that was reported to have a high level of suicidal ideation. Thus, in order to overcome this issue, all factors that influence suicidal ideation should be identified. This article is intended to identify the factor that influences suicidal ideation among higher learning education students based on their perceptions. This study was conducted using a qualitative method using semi-structured interview questions to explore participants’ perceptions towards suicidal ideation among students of higher learning institutions. As for data collection method, two focus group discussions were identified as main instrument. The findings show that factors identified to influence the existence of suicidal ideation among students of higher learning institutions can be categorized into two categories, external factors, and internal factors. These factors are peer pressure, pressure from society, social media influences, family factors, financial factors, intrapersonal and individual interpersonal factors, and low self-esteem factor. This study also found that counsellors and other professional bodies such as psychologists were not the choices of participants to express a problem that led to their suicidal ideation.
    Matched MeSH terms: Suicidal Ideation
  16. Ibrahim N, Amit N, Suen MW
    PLoS One, 2014;9(10):e110670.
    PMID: 25340331 DOI: 10.1371/journal.pone.0110670
    BACKGROUND: There has been a drastic increase in the rate of suicides over the past 45 years in Malaysia. The statistics show that adolescents aged between 16 and 19 years old are at high risk of committing suicide. This could be attributed to issues relating to the developmental stage of adolescents. During this stage, adolescents face challenges and are exposed to various stressful experiences and risk factors relating to suicide.

    METHOD: The present study examined psychological factors (i.e., depression, anxiety and stress) as predictors for suicidal ideation among adolescents. A cross-sectional study was conducted on 190 students (103 males and 87 females), aged 15 to 19 years old from two different schools in Kuala Lumpur. The Depression Anxiety Stress Scale 21-item version (DASS-21) was used to measure depression, anxiety and stress among the students, and the Beck Scale for Suicide Ideation (BSS) to measure suicidal ideation. The data were analysed using Pearson's correlation and multiple regression analysis.

    RESULTS: The results show that 11.10%, 10.00%, and 9.50% of the students reported that they were experiencing severe depression, anxiety and stress, respectively. There were significant correlations between depression, anxiety, and stress with suicidal ideation. However, only depression was identified as a predictor for suicidal ideation.

    CONCLUSION: Hence, this study extends the role of depression in predicting suicidal ideation among adolescents in the Malaysian context. The findings imply that teenagers should be assisted in strengthening their positive coping strategies in managing distress to reduce depression and suicidal ideation.

    Matched MeSH terms: Suicidal Ideation*
  17. Ibrahim N, Che Din N, Ahmad M, Amit N, Ghazali SE, Wahab S, et al.
    BMC Public Health, 2019 Jun 13;19(Suppl 4):553.
    PMID: 31196009 DOI: 10.1186/s12889-019-6861-7
    BACKGROUND: The high number of adolescents and young adults harbouring suicidal ideation, as reported by the Ministry of Health Malaysia, is alarming. This cross-sectional study aims to examine the association between social support and spiritual wellbeing in predicting suicidal ideation among Malaysian adolescents.

    METHODS: A total of 176 adolescents in selected urban areas in the states of Wilayah Persekutuan and Selangor were selected. The Suicide Ideation Scale (SIS) was used to measure the level of severity or tendency of suicidal ideation. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure the perceived social support received by the respondent while the Spiritual Wellbeing Scale (SWBS) was used to measure the religious wellbeing (RWB), the existential wellbeing (EWB) and the overall score of spiritual wellbeing (SWB).

    RESULTS: The study found that both RWB and EWB showed significant negative correlation with suicidal ideation. Similarly, support from family and friends also showed a negative correlation with suicidal ideation. Further analysis using multiple regressions showed that RWB and SWB, and family support predict suicidal ideation in adolescents.

    CONCLUSION: Spiritual wellbeing in combination with family support plays a major role in predicting suicidal ideation. Therefore, intervention for encompassing spirituality and family support may contribute to a more positive outcome in suicidal adolescents.

    Matched MeSH terms: Suicidal Ideation*
  18. Ibrahim N, Che Din N, Amit N, Ghazali SE, Mohd Safien A
    PLoS One, 2019;14(2):e0209971.
    PMID: 30811425 DOI: 10.1371/journal.pone.0209971
    INTRODUCTION: Despite suicide rate becoming a growing trend in research locally and globally, there is no standard measuring instrument developed in Malaysia. The aim of this study is to establish the first ever Malay version of suicide screening tool that is suitable and fit with multiracial and complex culture of Malaysia.

    METHODS: This study comprises of three phases, namely (1) items selection phase, (2) pilot study phase, and (3) scale validation phase. During the first phase, the items were selected from items pools which gathered from previous suicide ideation/ attitude scales. Then the pilot study was carried out to examine the items for Yatt Suicide Attitude Scale (YSAS). Lastly, the Yatt Suicide Attitude Scale (YSAS) validation study was conducted with 219 university students.

    RESULTS: Initial version of YSAS comprised 16 items and three components. After factor analysis, the questionnaire was reduced into only two components (Suicide Ideation and Suicide Attempt) with 5 items each. Both of the components obtained high reliability value (.89 and.86 respectively) and the questionnaire accounted for 67.84% of the total variance.

    CONCLUSION: The analysis showed that YSAS has an acceptable reliability and validity for Malaysian population. Although these findings corroborate literature on development of suicide ideation assessment instrument for specific cultural context, there is a need to further examine its reliability with clinical population and general population of different cultural context in Malaysia.

    Matched MeSH terms: Suicidal Ideation*
  19. Ibrahim N, Sherina MS, Phang CK, Mukhtar F, Awang H, Ang JK, et al.
    Med J Malaysia, 2017 08;72(4):221-227.
    PMID: 28889133 MyJurnal
    No abstract available.
    Matched MeSH terms: Suicidal Ideation*
  20. Ibrahim N, Amit N, Che Din N, Ong HC
    Psychol Res Behav Manag, 2017;10:129-135.
    PMID: 28496374 DOI: 10.2147/PRBM.S125176
    Suicide is a global phenomenon that has been showing an upward trend in recent years. It is the second leading cause of death among youth. Studies on suicidal ideation warrant greater attention, as it leads to suicide attempts and other health risk behaviors. Thus, the objective of this study was to compare gender differences in suicidal ideation and determine the predictors of suicidal ideation among youth. This cross-sectional study was carried out among 232 youths aged between 15 and 25 years from selected urban areas in Malaysia. The results showed that suicidal ideation was higher among male participants compared with female participants. Age was the predictor of suicidal ideation for males, while depression and loss of motivation, as components of hopelessness, were the predictors of suicidal ideation among females. Hence, it is important that professionals conduct early identification tests for suicidality among young people. This will facilitate the early detection of depression and hopelessness, which is important, in order to prevent suicidal behaviors or other problems before these occur.
    Matched MeSH terms: Suicidal Ideation
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