Self-harm is considered an important public health issue and is comprised by a wide range of definitions and behaviours. It is estimated that suicide affects more than 700,000 individuals every year, although, globally, there is a lack of evidence on other self-harm behaviour, such as attempted suicide. The objective of this study is to report and examine temporal trends of notifications, hospitalisations related to self-harm and suicide rates in Brazil between 2011 and 2022, as well as investigating differences in sociodemographic characteristics, methods, and region. This ecological study used secondary, Brazilian Health Information System data between 2011 and 2022. Self-harm notifications were collected from the Notifiable Diseases Information System (SINAN); self-harm hospitalisations from the Hospital Information System (SIH), and suicide data from the Mortality Information System (SIM). We calculated self-harm notifications, hospitalisations, and suicide rates by sex, age, race, region, and overall. We assessed time-related trends using Joinpoint regression analyses. From 2011 to 2022, 720,480 self-harm notifications, 104,458 self-harm hospitalisations, and 147,698 suicides were recorded in Brazil. In this period, self-harm notifications (AAPC: 21.13 (CI: 17.50, 25.33)) and suicide (AAPC: 3.70 (CI: 3.05, 4.38)) have increased in the country. Male adults (25–59 years old) and the elderly (>60 years old) continue to be the groups most affected by suicide, with respective rates of 9.59 and 8.60/100,000 in 2022. However, the largest percentage increases have been seen in young people (AAPC: 6.14 (CI: 4.57, 7.88)). The Indigenous population had the highest self-harm notification (103.72, 10,000) and suicide (16.58/100,000) rates, but the lowest hospitalisation rates (1.14/100,000) in 2022), compared to the overall population (70.06, 7.27, and 4.69/100,000, respectively, in 2022). The observed trend of increased self-harm notifications and suicide rates suggests the need for a greater allocation of resources to strategies to prevent self-harm and suicide. The Indigenous population seems to be the group with less access to healthcare. Research reported in this publication was supported by the 10.13039/100000025 National Institute of Mental Health of the 10.13039/100000002 National Institutes of Health under award number R01MH128911-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Objective: The presence of two or more chronic diseases results in worse clinical outcomes than expected by a simple combination of diseases. This synergistic effect is expected to be higher when combined with some conditions, depending on the number and severity of diseases. Multimorbidity is a relatively new term, with the first fundamental definitions appearing in 2015. Studies usually define it as the presence of at least two chronic medical illnesses. However, little is known regarding the relationship between mental disorders and other non-psychiatric chronic diseases. This review aims at investigating the association between some mental disorders and non-psychiatric diseases, and their pattern of association.Methods: We performed a systematic approach to selecting papers that studied relationships between chronic conditions that included one mental disorder from 2015 to 2021. These were processed using Covidence, including quality assessment.Results: This resulted in the inclusion of 26 papers in this study. It was found that there are strong associations between depression, psychosis, and multimorbidity, but recent studies that evaluated patterns of association of diseases (usually using clustering methods) had heterogeneous results. Quality assessment of the papers generally revealed low quality among the included studies.Conclusions: There is evidence of an association between depressive disorders, anxiety disorders, and psychosis with multimorbidity. Studies that tried to examine the patterns of association between diseases did not find stable results.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021216101, identifier: CRD42021216101.

Previous studies in Australia, Canada, and Brazil, found that suicide among ethnic minority groups is higher than in the general population. Indigenous peoples in Brazil have been reported to have a high suicide rate, with reports of suicide clusters occurring in several communities. The objective of this study was to report trends in countrywide suicide rates among Indigenous peoples in Brazil between 2000 and 2020, and to compare these with the non-Indigenous population. This ecological study used Indigenous suicide data collected from all regions of Brazil during a 21-year period, between 2000 and 2020. We used suicide estimates from the Mortality Information System (SIM), available at the Brazilian Health Ministry website (DATASUS). Suicide mortality rates by state and region were calculated using the estimated Indigenous population from the 2010 census, and estimated population proportions for the other years. We performed a trend analysis and compared trends in suicide between the Indigenous and non-Indigenous population during the period studied. Suicide rates among Indigenous Brazilians have reached more than two and a half times the levels for the overall Brazilian population in 2020 (17.57 suicide deaths versus 6.35 suicide deaths per 100,000 inhabitants, respectively). The Central-West region of Brazil had the highest suicide rates among Indigenous Brazilians over the study period, reaching 58.8 deaths/100,000 inhabitants in 2008. The younger age group (10–24 years old) had the highest suicide rates for all the years studied. Time-series analyses showed a trend of statistically significant increases in suicide rates in Brazil for both the Indigenous and non-Indigenous population during the study period. The North region, and specifically Amazonas state, has shown a decisive increase in suicide rates among the Indigenous populations. The suicide rate for Indigenous people in Brazil, excluding cases in Amazonas and Mato Grosso do Sul states, were similar to those for the entire Brazilian population, showing that the Indigenous peoples who are the most vulnerable to suicide reside in these locations. While there were statistically significant increases in suicide rates for all Brazilians over the study period, they remained alarmingly high among Indigenous people, compared to their non-Indigenous counterparts. The high suicide rates among Indigenous people, and younger individuals in particular (aged between 10 and 24), reinforces the need for specific prevention strategies for these populations. Further studies should be concentrated on determining risk factors in distinct ethnic groups, specifically within regions experiencing an elevated risk, such as the states of Amazonas and Mato Grosso do Sul. Research reported in this publication was supported by the 10.13039/100000025 National Institute of Mental Health of the National Institutes of Health under award number R01MH128911-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Objective: Multimorbidity, or the occurrence of two or more chronic conditions, is a global challenge, with implications for mortality, morbidity, disability, and life quality. Psychiatric disorders are common among the chronic diseases that affect patients with multimorbidity. It is still not well understood whether psychiatric symptoms, especially depressive symptoms, moderate the effect of multimorbidity on cognition. Methods: We used a large (n=2,681) dataset to assess whether depressive symptomatology moderates the effect of multimorbidity on cognition using structural equation modelling. Results: It was found that the more depressive symptoms and chronic conditions, the worse the cognitive performance, and the higher the educational level, the better the cognitive performance. We found a significant but weak (0.009; p = 0.04) moderating effect. Conclusion: We have provided the first estimate of the moderating effect of depression on the relation between multimorbidity and cognition, which was small. Although this moderation has been implied by many previous studies, it was never previously estimated.

Background: The association between alcohol problems and suicidal thoughts and behaviors (STB) is well documented, with recent evidence suggesting a causal effect of alcohol. Nevertheless, it is unclear if this relationship extends to less severe alcohol phenotypes. Moreover, only a few studies have explored whether STB may also increase alcohol use/problems. In this study, we combined two complementary methods to improve causal inference and investigate the bidirectional associations between alcohol use and STB. Methods: We used the National Longitudinal Study of Adolescent to Adult Health (Add Health) with information on alcohol use and suicide ideation and attempts across five waves of data (age ranges: 10–43). First, we fit a cross‐lagged panel model using data from Waves I–V to test the bidirectional associations between alcohol use and suicide ideation/attempt. This model advances causal knowledge by leveraging longitudinal data and controlling for unmeasured confounders related to both alcohol use and STB. Data from 17,908 unrelated participants were included in the model. Second, we included data from cousins, half‐siblings, full siblings, and monozygotic (MZ) twin pairs to perform co‐relative analyses, enhancing causal inference by controlling for unmeasured genetic and familial confounders. Results: Cross‐lagged findings showed small positive associations from suicide ideation to alcohol use ( β s = 0.045–0.050) and from alcohol use to suicide ideation ( β = 0.064) during adolescence/early adulthood in females. In males, results indicated one significant association between alcohol use in late adolescence and suicide attempt in adulthood ( β = 0.508). Co‐relative analyses revealed small but significant associations between alcohol use and STB in full siblings (OR = 1.41), but results in MZ twins were mostly inconclusive due to a lack of power. Conclusion: Our results suggest complex and potentially bidirectional associations between alcohol and suicide phenotypes, but do not provide strong evidence for a causal pathway.

Objective To investigate the clinical epidemiological characteristics of a large data set of visits to outpatient children mental health services in Brazil, as well as to identify relevant relationships between age, sex and three common mental disorders in childhood: pervasive developmental disorders, ADHD, and mild depressive disorders. Methods We extracted data from the Ambulatorial Information System (SIA) part of a public repository, Datasus, regarding child outpatient mental health services in Brazil, from 2008 to 2012. We performed an analysis of the number of visits per one hundred thousand inhabitants and further analyses with logistic regressions for ADHD (F90.0), Pervasive Developmental Disorders (F84.0-F84.9), and Mild Depressive Episode (F32.0) as outcomes, controlling for age, year of the visit, number of new CAPSI stratified by region. Results Attention-deficit hyperactivity disorder (ADHD) was the most common condition identified across the country. The analyses by region showed a high number of visits due to mental retardation in the Northeast and depressive episodes in the South. Regressions showed that older children are less likely to visit outpatient services with a diagnosis of ADHD (F90.0). Conclusions Our analysis shows the conditions which cause the most burden to the child psychiatry outpatient centers in Brazil and relevant differences between regions. This information has immediate use for the training of staff and allocation of resources in each region.