María Teresa Bobes Bascarán

Background: Suicide is a serious public health issue and the leading non-accidental cause of death among adolescents in Spain. Although a previous suicide attempt is the strongest risk factor for a new attempt, studies focused specifically on adolescent reattempters remain scarce. This study aims to identify modulating factors for suicide reattempts in a clinical adolescent population following an index attempt, using network analysis. Methods: We recruited a total of 287 adolescents aged 12 to 17, treated in emergency services after a recent suicide attempt. Data collection involved structured clinical interviews and validated self-report questionnaires assessing sociodemographic, psychopathological, and behavioral variables. Our network analysis explored significant correlations ( r ≥ 0.2) between variables and their relative influence on suicidal behavior, with a particular focus on reattempts (1-year follow-up). Results: Variables related to emotional and behavioral difficulties, childhood trauma, and depressive symptoms were the most central and influential within the network. In contrast, suicide reattempts and their frequency appeared as peripheral nodes with no significant direct associations. Emotional abuse was associated with a higher total number of suicide attempts, and the Self-Awareness of Mental Health intervention was linked to a longer time before reattempt. Conclusions: This study highlights the complexity of suicide reattempt risk factors in adolescents, emphasizing the importance of indirect interactions rather than isolated predictors. Incorporating standardized self-report tools may enhance clinical assessment and prevention strategies. Through network analysis, this research offers an innovative perspective to understand the multivariate nature of suicide risk in adolescent populations.

Background: Cohort studies of individuals with a suicide attempt are crucial for identifying risk and protective factors to prevent recurrence. The SURVIVE prospective cohort study aims to investigate the demographic and clinical profiles of individuals presenting with suicidal behaviour. Methods: A total of 1,741 individuals (289 adolescents aged 12–17 and 1,443 adults aged 18 and older) were recruited from emergency departments at eight hospitals across five Spanish regions following a suicide attempt. Baseline data were collected using structured clinical interviews and validated self-report instruments. Sociodemographic and psychiatric variables were analysed. Results: Most participants were female, and approximately 20% were migrants. Religious affiliation was reported by 35.6% of adolescents and 48.4% of adults. Depression and anxiety were the most prevalent psychiatric diagnoses, while trauma-related and eating disorders were more frequent in adolescents, and substance use disorders in adults. Non-suicidal self-injury was reported by 76.6% of adolescents and 40.1% of adults. The most common method of attempt was self-poisoning in both groups. Psychotropic medication use was widespread, with both groups receiving a similar number of prescriptions. Conclusions: The SURVIVE study provides a detailed characterization of suicide attempters in Spain, highlighting age-specific clinical patterns and contextual risk factors such as migration and religion. These findings underscore the need for tailored prevention strategies that consider developmental stage, psychiatric comorbidity, and social vulnerability.

Background/Objectives: Psychological pain—also termed psychache or mental pain—has been suggested to constitute a relevant factor in the emergence of suicidal behaviour. Despite conceptual advances, empirical research on interventions specifically designed to alleviate psychological pain in individuals who have attempted suicide remains scarce. The present scoping review maps existing psychological and pharmacological interventions targeting psychological pain, identifies their core components, delineates gaps for future research, and proposes a therapeutic intervention protocol. Methods: Literature was searched through PubMed, PsycInfo, and ClinicalTrials.gov (until October 2025) using combinations of the terms suicide, psychache, psychological pain, intervention, treatment, therapy, pharmacological treatment, and psychotherapy. Both randomised controlled trials, non-randomised controlled trials, and literature reviews were included. Results: Evidence indicates that few interventions explicitly target psychological pain. Most suicide-specific therapies indirectly address components of psychological pain—such as unbearable affect, loss of meaning, and social disconnection. Narrative-based, emotion regulation, and acceptance-based therapies appear promising. Emerging pharmacological approaches may relieve psychological pain; however, further evidence is required. Conclusions: Integrating psychological pain as a therapeutic focus—through narrative, tolerance-building, and relational strategies—may enhance post-attempt interventions. Future trials should systematically measure psychological pain and test its role as a mediator of suicidal outcomes.

Background: Identifying the key aspects of personal recovery in addictions is crucial for advancing recovery-oriented services. In Spain, no validated measures capture what service users consider most important for their recovery. This study aimed to design and validate the Personal Recovery Importance Scale (PRIS), an expanded CHIME-based instrument tailored to the addiction context. Method: A four-phase mixed-methods design involved experts (N = 13) and people in recovery (N = 1,604). Phase 1 focused on item development; Phases 2 and 3 assessed content and response process validity; and Phase 4 examined psychometric properties. Results: 42.4% of the items were revised after expert feedback and 44% following cognitive interviews. Psychometric analysis supported a seven-factor model (Connectedness, Hope, Identity, Meaning in life, Empowerment, Difficulties, and Practical support-CHIME-DP) with robust fit indices, invariance across recovery stages, satisfactory internal consistency, concurrent and discriminant validity, and hypothesis testing with key recovery variables. Conclusions: These findings confirm the content, face, and psychometric validity of the PRIS. This tool may be useful for prioritising and designing interventions and represents a first step towards developing PROMs and PREMs measures in Spain.

Background/Objectives: Psychological pain—also termed psychache or mental pain—has been suggested to constitute a relevant factor in the emergence of suicidal behaviour. Despite conceptual advances, empirical research on interventions specifically designed to alleviate psychological pain in individuals who have attempted suicide remains scarce. The present scoping review maps existing psychological and pharmacological interventions targeting psychological pain, identifies their core components, delineates gaps for future research, and proposes a therapeutic intervention protocol. Methods: Literature was searched through PubMed, PsycInfo, and ClinicalTrials.gov (until October 2025) using combinations of the terms suicide, psychache, psychological pain, intervention, treatment, therapy, pharmacological treatment, and psychotherapy. Both randomised controlled trials, non-randomised controlled trials, and systematic reviews were included. Results: Evidence indicates that few interventions explicitly target psychological pain. Most suicide-specific therapies indirectly address components of psychological pain—such as unbearable affect, loss of meaning, and social disconnection. Narrative-based, emotion regulation, and acceptance-based therapies appear promising. Emerging pharmacological approaches may relieve mental pain, however, further evidence is required. Conclusion: Integrating psychological pain as a therapeutic focus—through narrative, tolerance-building, and relational strategies—may enhance post-attempt interventions. Future trials should systematically measure psychological pain and test its role as a mediator of suicidal outcomes.

Background: The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a performance-based measure developed to assess functional capacity through simulations of daily activities. This study examined its psychometric properties in a Spanish sample, including individuals with first-episode psychosis (FEP), schizophrenia, and healthy controls. Methods: A total of 370 participants (99 FEP, 116 schizophrenia, and 155 controls) completed the VRFCAT in a multicenter study. Internal consistency (McDonald’s omega), discriminative validity (group comparisons and ROC curves), and convergent validity via correlations with cognitive performance and clinical symptoms were examined. Reference percentiles were calculated from the healthy control sample using quantile regression, stratified by age and education. Results: Item-level VRFCAT completion times showed acceptable to good internal consistency overall and in controls and schizophrenia samples, but poor in FEP. Differences in VRFCAT performance emerged ( χ ² = 108.88, p < .001), with controls performing best, schizophrenia worst, and FEP in between. ROC analyses indicated good discriminative accuracy in distinguishing patients from controls (area under the curve [AUC] = 0.779, sensitivity = 80.0%, specificity = 64.2%); but limited discrimination between schizophrenia and FEP. Age and education, but not sex, significantly affected performance. VRFCAT showed small-to-moderate correlations with cognitive performance, and no significant associations with symptom severity. Conclusions: The VRFCAT is a reliable and valid tool for assessing functional capacity in Spanish-speaking individuals with psychotic disorders. Its ecological validity, objectivity, psychometric properties, brief administration time, and ease of use support its potential use in clinical and research settings for evaluating functional recovery and treatment outcomes.

Background: Suicide represents a significant public health concern. Suicide prevention strategies are shifting toward transdiagnostic perspectives examining interrelated risk factors, but their interrelationships remain unclear. This study investigated relationships between psychopathological dimensions, impulsivity, and childhood maltreatment in individuals with suicidal ideation (SI), comparing those with versus without intention to act using network analysis. Methods: Data were obtained from the Suicide Prevention and Intervention Study project. Participants were categorized into two groups based on their intention to act according to the Columbia Suicide Severity Rating Scale. Psychological symptoms, impulsivity traits, and childhood maltreatment were assessed. Network analysis was performed, and centrality measures were computed. Results: A total of 1,265 individuals were categorized into the SI without intention to act (n = 345) and SI with intention to act (n = 920) groups. The former showed lower depression and hostility scores, and lower prevalence of major depressive and anxiety disorders. Network analyses revealed that in the SI without intention to act group, obsessive-compulsive symptoms were central, connecting to depression and anxiety, while negatively correlating with non-planning impulsivity. In contrast, the SI with intention to act group showed a more densely interconnected network where emotional abuse served as a bridge between childhood maltreatment and other psychopathological dimensions. Conclusions: This study identifies symptom interaction patterns between individuals with SI without and with intention to act. Understanding these relationships may improve suicide risk assessment and inform personalized interventions, potentially reducing the transition from ideation to action. Trauma-focused approaches addressing emotional abuse may be especially relevant for individuals at high risk.

Background: Cognitive impairment is central to psychosis and strongly linked to functional outcomes. The Brief Assessment of Cognition (BAC) app is a tablet-based, automated tool for assessing key cognitive domains but has not been validated in Spanish-speaking populations or across illness stages. Methods: A total of 402 participants (117 with first-episode psychosis [FEP], 125 with schizophrenia, and 160 controls) completed the BAC app along with clinical and functional assessments. We evaluated internal consistency, group differences, convergent and discriminant validity, and the effects of sex, age, and education. Normative percentiles were derived from controls. Results: The BAC app showed good internal consistency across groups (α = 0.76–0.87) and effectively differentiated individuals with psychosis from controls (area under the curve [AUC] = 0.862), with performance declining from controls to FEP to schizophrenia. Discrimination between FEP and schizophrenia was limited (AUC = 0.649). BAC App correlated positively with estimated intelligence quotient and functional capacity, and negatively with symptom severity, particularly in FEP. Performance varied by age, sex, and education, supporting the need for stratified normative data. Conclusions: The BAC app showed strong reliability and validity for cognitive assessment in Spanish-speaking individuals with psychosis. Its brevity, automated scoring, and normative data support its clinical and research applications for cognitive screening, monitoring, and treatment evaluation.

Background: Adolescents are at a heightened risk of suicide reattempts following hospital discharge, but few evidence-based interventions exist. This study evaluated the efficacy of the self-awareness of mental health (SAM) program combined with treatment as usual (TAU) versus TAU alone in reducing reattempts among high-risk adolescents. Methods: A randomized clinical trial was conducted across nine Spanish hospitals (January 2021–March 2024) with 261 adolescents (12–17 years) who had attempted suicide within the last 15 days. Participants were assigned to SAM + TAU (n=128) or TAU (n=133), with 12-month follow-up. The primary outcome was suicide reattempts within 12 months; secondary analyses examined time to reattempt and associated risk factors. Results: After 12-months, no significant differences were found in reattempt rates [22.6% (SAM) versus 27.8% (TAU); OR=0.610, 95%CI (0.321–1.151), p=0.127] or time to reattempt [HR=0.606, 95%CI (0.390–1.021), p=0.060]. In SAM, attentional impulsivity emerged as a significant risk factor [HR=1.126, 95% CI (1.004–1.263), p=0.043], while nonplanning impulsivity was protective [HR=0.878, 95%CI (0.814–0.948), p<0.001]. In TAU, increased suicide risk was linked to suicidal intentionality [HR=1.341, 95%CI (1.009–1.782), p=0.044] and more prior attempts [HR=1.230, 95%CI (1.039–1.457), p=0.016]. Conversely, fewer psychiatric diagnoses emerged as a protective factor [HR=0.821, 95%CI (0.677–0.996), p=0.045]. Conclusions: While no significant differences were found between groups, SAM identified important psychological factors influencing suicide risk. These findings provide a foundation for targeted interventions to prevent reattempts in adolescents.