This is a summary of the latest significant Canadian (🇨🇦) and international suicide research we collected in the past month:

Beautrais, A. (2020). Stress and suicide in medical students and physiciansThe New Zealand Medical Student Journal, 30, 11-14.
Physicians are one of the most at-risk professions for suicide. This paper examines those pervasive risks in the profession and in medical school as well.

Abstract: Suicide is the second most common cause of death for medical students, after accidents. Once they have graduated, physicians have higher rates of suicide than the general population, and are consistently at the top of rankings for occupational groups at risk of suicide. However, we should be careful to avoid alarming medical students with these statistics.

Costanza, A., et al. (2020). Suicide prevention from a public health perspective. What makes life meaningful? The opinion of some suicidal patientsActa Biomed, 91(3), 128-134.
Compared to studies on the risk factors for suicide, factors which protect us from suicide are woefully under-researched. This paper looks at a significant protective factory-Meaning in life(MiL)-and the themes respondents identified as meaningful.

Abstract: Background and aim of the work: Suicide is a worldwide phenomenon, with a relevant number of victims. Moreover, repercussions of suicidality-across its entire spectrum-involve not only the individual but also survivors and communities, in a profound and lasting way. As such, suicidality represents a crucial public mental health concern, in which risk/protection factors’ study represent a key issue. However, research primarily focused on suicidality risk factors. This study, moving from Frankl’s first observations on “Meaning in Life” (MiL) as protective against suicidality, aimed to identify the main themes that suicidal patients identified as MiL carriers, or potential carriers, in their existences. Methods – Qualitative study on 144 patients admitted to the Geneva University Hospital’s emergency department for suicidal ideation (SI) and suicide attempt (SA). Results – Interpersonal/affective relationships constituted the main theme (71.53%), with emphasis on family (39.80%), children/grandchildren (36.89%). Profession/education, intellectual/non-intellectual pleasures, and transcendental dimension also emerged. Conclusions – These aspects could be considered among a public health agenda’s points for suicide prevention programs taking into account also protective factors promotion/support, including community’s mental health resources. Reconnecting to introduction’s historical part, our findings are consistent with Frankl’s observations. Even if exposed to “absurd” and reluctant to deliberate on this, he seems approach Camus conceptualization who, confronted to the necessity of predictable and conform to recognizable personal patterns transcending chaos for a sense-giving perspective, invited to imagine that a meaning, even a “non-absolute meaning”, may lie in apparent smallest things and that Sisyphus can have “the possibility to revolt by trying to be happy”.

Gunnell, D., et al. (2020). Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry. Published online 21 April 2020, DOI.org/10.1016/S2215-0366(20)30171-1
This timely commentary reminds us that there are robust and efficacious mental health resources available to meet the demands of the pandemic that should be employed as strongly as possible.

Abstract: The mental health effects of the coronavirus disease 2019 (COVID-19) pandemic might be profound and there are suggestions that suicide rates will rise, although this is not inevitable. Suicide is likely to become a more pressing concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups. Preventing suicide therefore needs urgent consideration. The response must capitalise on, but extend beyond, general mental health policies and practices.

(🇨🇦) Ligier, F., et al. (2020). Being pro-active in meeting the needs of suicide-bereaved survivors: Results from a systematic audit in MontrealBMC Public Health, DOI:10.21203/rs.3.rs-17474/v1
Research on those bereaved by suicide is not plentiful. This Canadian study shows many areas where the needs of those bereaved can be better served.

Abstract: Suicide is a major public health concern that affects some 3,500 individuals a year in Canada. According to the literature, each suicide affects an average of six people. The aim of this study was to describe the met and unmet needs of suicide-bereaved survivors and to formulate postvention recommendations. Methods In the context of an exploratory mixed-methods audit of 39 suicides that occurred in Montreal (Canada) in 2016, suicide-bereaved survivors ( n = 29) participated in semi-structured interviews and completed instruments to assess pathological grief, depression (PHQ-9), and anxiety (GAD-7). Results Mean age of participants was 57.7 years; 23 were women. Although help was offered initially, in most cases by a health professional or service provider (16/29), 22 survivors would have liked to be contacted by telephone in the first two months post suicide. Four categories of individual unmet needs (medical/pharmacological, information, support, and outreach) and one collective unmet need (suicide pre/postvention training and delivery) emerged. Conclusions Although there have been provincial initiatives in favor of suicide-bereaved survivors in the past decade, many dwindled over time and none has been applied systematically. Recommendations for different stakeholders (Ministry of Health and Social Services, coroners, NGOs, and representatives of suicide-bereaved survivors) outlined in this study could be an interesting first step to help develop a provincial suicide pre/postvention strategy.

(🇨🇦) Orpana, H., et al. (2020). Alcohol and other drugs in suicide in Canada: opportunities to support prevention through enhanced monitoringInjury Prevention. DOI:10.1136/injuryprev-2019-043504
A Canadian literature review of publications from 1998 to 2018 of the role acute alcohol and drug consumption has prior to suicidal death.

Abstract: The use of alcohol and other drugs has been identified as a significant factor related to suicide through multiple pathways. This paper highlights current understanding of their contributions to suicide in Canada and identifies opportunities for enhancing monitoring and prevention initiatives. Publications from 1998 to 2018 about suicide in Canada and that referred to alcohol or other drugs were identified using PubMed and Google Scholar. A second literature search restricted to articles including results of toxicology testing was conducted by a librarian. We summarised the literature identified on ecological analyses, attributable fractions and deaths, and research including the results of toxicological analyses. Our literature search yielded 5230 publications, and 164 documents were identified for full- text screening. We summarised the findings from 30 articles. Ecological analyses support the association between alcohol sales, annual per capita alcohol consumption and suicide rates. Based on published estimates, approximately a quarter of suicide deaths in Canada are alcohol- attributable, while the estimated attributable fraction for illegal drugs is more variable. Finally, there is a dearth of literature examining the role of acute alcohol and/or drug consumption prior to suicide based on toxicological findings. The proportion of suicide decedents with drugs or alcohol present at the time of death varies widely. While there is evidence on the role of alcohol and drugs in suicide deaths, there is not a large body of research about the acute use of these substances at the time of death among suicide decedents in Canada. Our understanding of the role of alcohol and other drugs in suicide deaths could be enhanced through systematic documentation, which in turn could provide much needed guidance for clinical practice, prevention strategies and policy initiatives.

Saadi,, et al. (2020). The impact of gun violence restraining order laws in the U.S. and firearm suicide among older adults: A longitudinal state level analysis, 2012–2016BMC Public Health, DOI.org/10.1186/s12889-020-08462-6
A study examining whether Gun Violence Restriction Order (GVRO) laws have a protective effect on older adult suicide rates in the United States.

Abstract: Background – Older adults complete suicide at a disproportionately higher rate compared to the general population, with firearms the most common means of suicide. State gun laws may be a policy remedy. Less is known about Gun Violence Restricting Order (GVRO) laws, which allow for removal of firearms from people deemed to be a danger to themselves or others, and their effects on suicide rates among older adults. The purpose of this study was to examine the association of state firearm laws with the incidence of firearm, non-firearm-related, and total suicide among older adults, with a focus on GVRO laws. Methods – This is a longitudinal study of US states using data from 2012 to 2016. The outcome variables were firearm, non-firearm and total suicide rates among older adults. Predictor variables were [1] total number of gun laws to assess for impact of overall firearm legislation at the state level, and [2] GVRO laws. Results – The total number of firearm laws, as well as GVRO laws, were negatively associated with firearm-related suicide rate among older adults ages 55–64 and > 65 years-old (p < 0.001). There was a small but significant positive association of total number of firearm laws to non-firearm-related suicide rates and a negative association with total suicide rate. GVRO laws were not significantly associated with non-firearm-related suicide and were negatively associated with total suicide rate. Conclusion – Stricter firearm legislation, as well as GVRO laws, are protective against firearm-relate suicides among older adults.

Testoni, I., et al. (2020). Beyond the wall: Death education at middle school as suicide preventionInternational Journal of Environmental Research and Public Health. DOI:10.3390/ijerph17072398
An Italian study of the use of “death education” in the classroom as an upstream suicide prevention tool for middle-schoolers.

Abstract: This study investigates the psychological effects of participation in Death Education (DeEd) by middle school children in two towns in northeast Italy in which suicides occur to a greater extent than in the rest of the region. The aims of the project “Beyond the Wall” were inherent to the prevention of suicide, address existential issues and enhance the meaning of life through positive intentions for the future and reflection on mortality. It involved eight classes (150 students in four classes in the experimental group; 81 in four classes in the control group) engaging with films, workgroup activities, photovoice and psychodrama. The constructs of resilience, emotional competency and psychological well-being were monitored with the Resilience Scale for Adolescents, the Hopelessness Scale for Children, the Alexithymia Questionnaire for Children and the Stirling Children’s Well-being Scale. The DeEd intervention was found to be significantly related to some of the variables investigated, improving the students’ ability to recognise emotions and communicate them verbally while maintaining stable initial characteristics, such as psychological well-being and positive expectations for the future.

(🇨🇦) Thompson, L.H., et al. (2020). Participatory model building for suicide prevention in CanadaInternational Journal of Mental Health Systems,14:27, DOI.org/10.1186/s13033-020-00359-6
An analysis of a workshop employing participatory model building to develop a conceptual model of suicide prevention in Canada. The workshop attendees were employees of the Public Health Agency of Canada (PHAC) working in suicide prevention.

Abstract: Background – Suicide is a behaviour that results from a complex interplay of factors, including biological, psychological, social, cultural, and environmental factors, among others. A participatory model building workshop was conducted with fifteen employees working in suicide prevention at a federal public health organization to develop a conceptual model illustrating the interconnections between such factors. Through this process, knowledge emerged from participants and consensus building occurred, leading to the development of a conceptual model that is useful to organize and communicate the complex interrelationships between factors related to suicide. Methods – A model building script was developed for the facilitators to lead the participants through a series of group and individual activities that were designed to elicit participants’ implicit models of risk and protective factors for suicide in Canada. Participants were divided into three groups and tasked with drawing the relationships between factors associated with suicide over a simplified suicide process model. Participants were also tasked with listing prevention levers that are in use in Canada and/or described in the scientific literature. Results – Through the workshop, risk and prevention factors and prevention levers were listed and a conceptual model was drafted. Several “lessons learned” which could improve future workshops were generated through reflection on the process. Conclusions – This workshop yielded a helpful conceptual model contextualising upstream factors that can be used to better understand suicide prevention efforts in Canada.

Kawohl, W., et al. (2020). COVID-19, unemployment, and suicideThe Lancet Psychiatry, 7(5), 389-390. Published online 1 May 2020. DOI.org/10.1016/S2215-0366(20)30141-3.
Noted Swiss researchers predict a rise in suicide due to unemployment from the COVID-19 pandemic.

Abstract: The COVID-19 pandemic has led to the introduction of strong restrictive measures that are having a substantial effect on the global economy, including an increase in the unemployment rate worldwide. In a previous study, we modelled the effect of unemployment on suicide on the basis of global public data from 63 countries, and we observed that suicide risk was elevated by 20–30% when associated with unemployment during 2000–11 (including the 2008 economic crisis). We have now used this model to predict the effects of the currently expected rise in the unemployment rate on suicide rates.