Very rare effects include abnormal behaviour, psychosis, suicidal ideation, suicide attempts and suicide. Another study investigated strictly suicidal ideation in adolescents. Life events are strong predictors of increased risk for suicidal ideation. Depression with suicidal ideation may develop in heavy users. Suicidal ideation and behavior in clinical trials are rare. Depression with suicidal ideation may develop in very heavy users. They may also cause psychological distress, which is another symptom associated with suicidal ideation. Prescribing medication to treat suicidal ideation can be difficult. It is also associated with increased suicidal ideation and death by suicide. LGBT Mormon suicides and experiences with suicidal ideation have received media coverage. The victims are at risk of anxiety, dissociation, depression, shame, low self-esteem and suicidal ideation. It also protects against depression, substance abuse, and suicidal ideation and behaviors. Multiple times, Shepard was hospitalized due to his clinical depression and suicidal ideation. Suicidal ideation, failed suicide attempts, and self-harm also occur. Problem gambling is associated with increased suicidal ideation and attempts compared to the general population.