Machine learning analysis of social media data represents a promising way to capture longitudinal environmental influences contributing to individual risk for suicidal thoughts and behaviors. Our objective was to generate an algorithm termed "Suicide Artificial Intelligence Prediction Heuristic (SAIPH)" capable of predicting future risk to suicidal thought by analyzing publicly available Twitter data. We trained a series of neural networks on Twitter data queried against suicide associated psychological constructs including burden, stress, loneliness, hopelessness, insomnia, depression, and anxiety. Using 512,526 tweets from N = 283 suicidal ideation (SI) cases and 3,518,494 tweets from 2655 controls, we then trained a random forest model using neural network outputs to predict binary SI status. The model predicted N = 830 SI events derived from an independent set of 277 suicidal ideators relative to N = 3159 control events in all non-SI individuals with an AUC of 0.88 (95% CI 0.86-0.90). Using an alternative approach, our model generates temporal prediction of risk such that peak occurrences above an individual specific threshold denote a~7 fold increased risk for SI within the following 10 days (OR = 6.7 ± 1.1, P = 9 × 10 −71). We validated our model using regionally obtained Twitter data and observed significant associations of algorithm SI scores with county-wide suicide death rates across 16 days in August and in October, 2019, most significantly in younger individuals. Algorithmic approaches like SAIPH have the potential to identify individual future SI risk and could be easily adapted as clinical decision tools aiding suicide screening and risk monitoring using available technologies.

Findings suggest that mindfulness is feasible for individuals with SPMI, and displays potential benefits in outcomes aside from psychotic symptoms. The effects of mindfulness in psychotic symptoms needs further investigation in larger definitive studies using methodological rigor and thorough assessments of other psychiatric populations who are also representative of SPMI.

Although Canada is often perceived as tolerant of diversity, our data regarding poor follow-up in black patients indicate similar problems to those reported in the United Kingdom and United States. Clinicians may have low expectations for visible minority patients and thus notice more consistently when these patients adhere to treatment. This is the first study to examine ethnic differences in adherence to first-episode psychosis follow-up in a Canadian setting.

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