Ana Voichita Tebeanu

Background: Suicide is often said to kill more young people than cancer, but the size of the difference has rarely been quantified. Methods: we analysed registered deaths at ages 15 to 24 from the WHO Mortality Database, Eurostat for the European Union, and WHO Global Health Estimates as a modelled comparison, and conducted a PRISMA 2020 systematic review of MEDLINE via PubMed and Europe PMC, supplemented by OpenAlex and Crossref, to establish whether the quantity had already been reported. Ages 15 to 24 were used because no multi-country source publishes the 18 to 25 band. Results: in the 66 countries with low ill-defined-cause coding, 24,040 suicide deaths and 12,778 cancer deaths gave a ratio of 1.88 (95% CI 1.84 to 1.92); the ratio was 3.07 in high-income countries and 2.25 in males against 1.32 in females. On a balanced panel of 56 countries it widened by 43 per cent between 2005 and 2022, because registered cancer deaths fell while suicide deaths rose. Of 696 screened records plus a supplementary search, 23 studies were eligible and none of the 12 reports obtained states the ratio. Conclusions: where cause of death is relatively well coded, suicide accounts for close to twice as many deaths at ages 15 to 24 as cancer, and for about three times as many in high-income countries.

Background/Objectives: Suicide remains a major public health concern, with over 700,000 deaths annually worldwide. Current risk assessment is limited by the tendency of at-risk patients to deny suicidal ideation, with denial rates of approximately 50% among ideators and up to 78% among inpatient suicide decedents. Methods: This proof-of-concept study investigated whether deep learning applied to patient speech could distinguish psychiatric inpatients admitted following a recent suicide attempt from patients with severe depression without documented suicidal ideation. A multi-scale two-dimensional convolutional neural network with residual connections and spatial attention (Multi-Scale CNN) was trained on mel-spectrograms generated exclusively from patient speech extracted by automatic speaker diarization followed by manual verification. The dataset comprised recordings from 88 psychiatric inpatients (59 suicide attempters and 29 patients with severe depression without suicidal ideation). Model performance was evaluated using repeated patient-level stratified five-fold cross-validation, ensuring complete separation of participants between folds. Additional female-only, exploratory male-only, and repeated sex-matched analyses were performed to evaluate the potential influence of sex imbalance. Results: Repeated patient-level five-fold cross-validation yielded a mean classification accuracy of 72.7 ± 6.4% with a mean ROC-AUC of 0.824 ± 0.054, a sensitivity of 88.3 ± 9.5%, and a specificity of 41.3 ± 25.0%. Female-only analysis maintained good discriminative performance (ROC-AUC 0.866 ± 0.123), whereas repeated sex-matched analyses produced lower performance (ROC-AUC 0.621 ± 0.156), indicating that sex imbalance contributed to, but did not fully explain, the observed discrimination. The male-only analysis was considered exploratory because of the limited number of male patients in the depression group. Conclusions: These findings support the feasibility of voice-based patient-level analysis as a complementary objective approach for suicide risk assessment. Although the study remains exploratory because of the limited sample size and the absence of external validation, the revised validation strategy and sex-controlled analyses provide a substantially more robust estimate of model performance. Further multicenter prospective studies are required before clinical implementation.

This chapter considers the problematic of ethics in clinical research in the countries that are new in terms of implementation or building an adequate structure. The chapter intends to assess the extent to which the clinical trials performed in four former communist East-European countries considered the ethical norms into their research procedures. A framework of existing literature on ethics in clinical research, along with the regional context, is discussed in the next section. The methods section includes the instruments, sources, and procedures for data collection. The data analysis procedures and structure are further explained and grounded relative to the study main purpose. The next section includes the facts and figures on the presence of ethical requirements in clinical trials in the specific political and cultural background in a number of former European communist countries. Finally, a number of suggestions and recommendation are also discussed.