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

🇨🇦 Mental Health Commission of Canada. (2021). Considerations for implementing a three-digit suicide prevention number in Canada: Policy brief.
A policy document from the Mental Health Commission of Canada (MHCC) advocating for the adoption and implementation of a three-digit suicide prevention number in Canada.

Abstract – Purpose: The purpose of this policy brief is to outline considerations for implementing a three-digit suicide prevention number in Canada. It reviews several relevant international contexts; specifically, the implementation of a three-digit suicide prevention and mental health crisis hotline (988) in the United States (U.S.) and the recently approved 113 number in the Netherlands. In addition, it provides findings from a short survey of people living in Canada on the potential benefits and challenges of a three-digit number, the expectations on how the system would work, and the use of a three-digit number (versus the 11-digit number currently in use by the Canada Suicide Prevention Service [CSPS]). The brief is based on the survey, informal interviews, and a scan of academic and grey literature by the Mental Health Commission of Canada (MHCC). The considerations it explores include the accessibility and visibility of the service, the capacity of crisis centres, training and staffing standardization, funding and operating costs, and the three-digit number selection.

Kolves, K., et al. (2021). Assessment of suicidal behaviors among individuals with autism spectrum disorder in Denmark. JAMA Network Open, 4(1), e2033565. DOI: 10.1001/jamanetworkopen.2020.33565
The association between autism and suicidality is under-researched, although less so than in the past. This longitudinal cohort study investigates this association using population-level data from a national register in Denmark.

Abstract – Objectives: To analyze whether people with ASD have higher rates of suicide attempt and suicide compared with people without ASD using national register data, identify potential risk factors for suicide attempt and suicide among those with ASD, and examine associations with comorbid disorders. Design, setting, and participants: In this cohort study, nationwide register data from January 1, 1995, to December 31, 2016, were gathered on 6 559 266 individuals in Denmark aged 10 years or older. Statistical analysis was performed from November 20, 2018, to November 21, 2020. Main outcomes and measures: Rates of suicide attempt and suicide among persons with ASD were compared with rates among persons without ASD, using Poisson regression models to calculate incidence rate ratios adjusted for sex, age, and time period. Results: Of the total study population of 6 559 266 individuals, 35 020 individuals (25 718 male [73.4%]; mean [SD] age at diagnosis, 13.4 [9.3] years) received a diagnosis of ASD. A total of 64 109 incidents of suicide attempts (587 [0.9%] among individuals with ASD) and 14 197 suicides (53 [0.4%] among individuals with ASD) were recorded. Persons with ASD had a more than 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) than those without ASD. For individuals with ASD, the aIRR for suicide attempt among female individuals was 4.41-fold (95% CI, 3.74-5.19) higher compared with male individuals; for individuals without ASD, the aIRR for female individuals was 1.41-fold (95% CI, 1.39-1.43) higher compared with male individuals. Higher rates of suicide attempt were noted across all age groups for those with ASD. Persons with a diagnosis of ASD only had an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt, whereas those with other comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.10) for suicide attempt compared with those without any psychiatric disorders. A total of 542 of 587 individuals with ASD (92.3%) who attempted suicide had at least 1 other comorbid condition and 48 of 53 individuals with ASD (90.6%) who died by suicide had at least 1 other comorbid condition. Conclusions and relevance: This nationwide retrospective cohort study found a higher rate of suicide attempt and suicide among persons with ASD. Psychiatric comorbidity was found to be a major risk factor, with more than 90% of those with ASD who attempted or died by suicide having another comorbid condition. Several risk factors are different from the risk factors in the general population, which suggests the need for tailored suicide prevention strategies.

Chandler, A. (2021). Masculinities and suicide: Unsettling ‘talk’ as a response to suicide in men. Critical Public Health. DOI: 10.1080/09581596.2021.1908959
An exploratory interview study of 10 men in the United Kingdom who had self-harmed, attempted suicide, or had planned suicide in the past. The authors challenge the assumption that public health campaigns encouraging male conversation surrounding suicide are unequivocally positive initiatives.

Abstract – An increasingly common way that high rates of male suicide are understood is via men’s ostensibly poorer abilities to talk about – and more generally seek help for – problems in general, and emotional problems specifically. This has led to the development of public mental health campaigns which urge men to ‘speak up’ more often about the problems they face. I argue that both the initial claim, and the enactment of this claim in public mental health campaigns, is problematic, resting on simplistic assumptions about men and gender difference, and serving to detract attention from structural drivers of suicide. Drawing on a narrative analysis of in-depth interviews with ten men who had self-harmed, thought about, or attempted suicide, this paper focuses attention on the content and contexts of ‘talk’. I argue that public health campaigns promoting ‘talk’ in response to male suicide neglect the interpersonal and structural contexts in which talk occurs, including considerations of power and structural inequalities.

Wang, S.B., et al. (2021). A pilot study using frequent inpatient assessments of suicidal thinking to predict short-term postdischarge suicidal behavior. JAMA Network Open, 4(3), e210591. DOI: 10.1001/jamanetworkopen.2021.0591
In this study inpatient assessments were conducted measuring suicidal ideation during hospitalization. Their responses were analyzed for predictive outcomes of suicidal behaviors following discharge.

Abstract – Importance: The weeks following discharge from psychiatric hospitalization are the highest-risk period for suicide attempts. Real-time monitoring of suicidal thoughts via smartphone prompts may be more indicative of short-term risk than a single, cross-sectional assessment. Objective: To test whether modeling dynamic changes in real-time suicidal thoughts during psychiatric hospitalization can improve predictions of postdischarge suicide attempts vs using only baseline (ie, admission) data or using the mean level of real-time suicidal thoughts during hospitalization. Design, setting, and participants: In this prognostic study, 83 adults recruited from the inpatient psychiatric unit at Massachusetts General Hospital completed ecological momentary assessment surveys of suicidal thinking 4 to 6 times per day during hospitalization as well as brief follow-up surveys assessing suicide attempts at 2 and 4 weeks after discharge. Participants completed at least 3 real-time monitoring surveys. Inclusion criteria included hospitalization for suicidal thoughts and/or behaviors and English fluency. Data were collected from January 2016 to December 2018 and analyzed from January to December 2020. Main outcomes and measures: The primary outcome was suicide attempt in the month after discharge. Results: Of 83 participants (mean [SD] age, 38.4 [13.6] years; 43 [51.8%] male participants; 69 [83.1%] White individuals), 9 (10.8%) made a suicide attempt in the month after discharge. Mean cross-validated AUC for elastic net models revealed predictive accuracy was fair for the model using baseline data (area under the curve [AUC], 0.71; first to third quartile, 0.55-0.88), good for the model using the mean level of real-time suicidal thoughts during hospitalization (AUC, 0.81; first to third quartile, 0.67-0.91), and best for the model using dynamic changes in real-time suicidal thoughts during hospitalization (AUC, 0.89; first to third quartile, 0.81-0.97); this pattern of results held for other classification metrics (eg, accuracy, positive predictive value, Brier score) and when using different cross-validation procedures. Features assessing rapid fluctuations in suicidal thinking emerged as the strongest predictors of posthospital suicide attempts. A final set of models incorporating percentage missingness further improved both the mean (mean AUC, 0.93; first to third quartile, 0.90-1.00) and dynamic feature (mean AUC, 0.93; first to third quartile, 0.88-1.00) models. Conclusions and relevance: In this study, collecting real-time data about suicidal thinking during the course of hospitalization significantly improved short-term prediction of posthospitalization suicide attempts. Models including dynamic changes in suicidal thinking over time yielded the best prediction; features that captured rapid changes in suicidal thoughts were particularly strong predictors. Survey noncompletion also emerged as an important predictor of posthospitalization suicide attempts.

Mennicke, A., et al. (2021). Suicide completion among incarcerated women. Journal of Correctional Health Care, 27(1), 14-22. DOI: 10.1089/jchc.18.12.0070
Data from The National Violent Death Reporting System in the United States are culled to determine contributing factors for 176 suicides of incarcerated women from 2003 and 2015.

Abstract – Little is known about factors that contribute to suicide completion among women who are incarcerated. The current study used data from the National Violent Death Reporting System to examine contributing factors for 176 suicide deaths from 2003 to 2015 in 21 states among women who were incarcerated. Common circumstances for suicide completion included mental health and substance use challenges. Women experienced these problems at rates higher than men who were incarcerated and completed suicide. In addition, women were more often the victim of violence and abuse. Qualitative narratives were coded, revealing that isolation and health concerns may also contribute to suicide risk for women who are incarcerated.

Beghi, M., et al. (2021). Suicidal behaviour in older age: A systematic review of risk factors associated to suicide attempts and completed suicides. Neuroscience and Biobehavioral Reviews. DOI: 10.1016/j.neubiorev.2021.04.011
A lengthy systematic review looking at 39 population-based studies of older adults and suicide. The most frequent 28 risk factors are listed and presented.

Abstract – In older age, several observational studies investigated risk factors for suicide attempts/completed suicides, however, contrasting evidence came from population-based setting. In the present systematic review, we described through a narrative synthesis the significant associations existing among risk factors and suicide attempts/completed suicides in subjects aged >65 years. From the 39 population-based studies selected in six different databases until February 15, 2021, we analyzed the most frequent 28 risk factors for suicidal behaviour. The risk factors more associated to suicide attempts than other variables frequently related to suicidal behavior in older age were depressive disorders, methods employed to self-harm (particularly poisoning), and psychotropic drug utilization followed by psychological factors and disability. Moreover, male sex, violent methods to self-harm, any psychiatric disorder (depression, anxiety and bipolar disorders), a poor medical condition, stressors/bereavement, and living alone appeared to be more significant for predicting completed suicides in late life. In older age, efforts for suicide prevention should be based on strategies to assess and treat psychiatric disorders along with psychological interventions, particularly in males.

Fitzpatrick, S.J. (2021). The moral and political economy of suicide prevention. Journal of Sociology. DOI: 10.1177/14407833211001112
An analysis of how suicide prevention operates within systems that include social, economic, political and moral considerations.

Abstract – Suicide prevention occurs within a web of social, moral, and political relations that are acknowledged, yet rarely made explicit. In this work, I analyse these interrelations using concepts of moral and political economy to demonstrate how moral norms and values interconnect with political and economic systems to inform the way suicide prevention is structured, legitimated, and enacted. Suicide prevention is replete with ideologies of individualism, risk, and economic rationalism that translate into a specific set of social practices. These bring a number of ethical, procedural, and distributive considerations to the fore. Closer attention to these issues is needed to reflect the moral and political contexts in which decision-making about suicide prevention occurs, and the implications of these decisions for policy, practice, and for those whose lives they impact.

Anestis, M.D., et al. (2021). An examination of preferred messengers on firearm safety for suicide prevention. Preventive Medicine. 145. DOI: 10.1016/j.ypmed.2021.106452
A survey of American citizens was conducted to gauge preference for messaging on the topic of safe firearm storage. The respondents were firearms owners, non-firearms owners and firearm owners of different racial groups and sexes. The differing messengers were members of law enforcement, military personnel, military veterans, physicians, and celebrities.

Abstract – This study sought to determine differences in preferred messengers on the topic of safe firearm storage and suicide prevention between firearm owners and non- firearm owners, and among firearm owners of different racial groups and sexes. Participants were 6200 United States residents recruited via Qualtrics Panels to complete an online survey. Data were collected during March 2020. The total sample and all subsamples ranked law enforcement, current military personnel, and military veterans as the top three most credible sources to discuss firearm safety for suicide prevention. Significant differences existed among the mean ranking of sources between firearm owners and non-firearm owners as well as between several subgroups of firearm owners. The identical ranking of the top three sources indicates that these groups agree on the relative credibility of multiple sources, although the average level of credibility for particular sources may vary. These findings highlight that the effectiveness of messaging on safe firearm storage may hinge on the identity of the individual delivering the message and provide an initial roadmap for how to consider packaging specific messages.

🇨🇦 Qui, T. & Klonsky, E.D. (2021). Deciding to Die: The Relations of Decision-making Styles to Suicide Ideation and Attempts. International Journal of Cognitive Therapy. DOI: 10.1007/s41811-021-00107-9
This is an examination and comparison of differing decision-making styles among those who have experienced suicidal ideation exclusively with those who have attempted suicide.

Abstract – Research has struggled to distinguish individuals who have attempted suicide from individuals with suicidal thoughts but no history of suicide attempts. Cognitive attributes such as decision-making mediate thought-behavior relationships; we therefore examined whether different decision-making styles distinguished those who had made suicide attempts from those with suicidal ideation only. Six hundred participants were recruited using Amazon’s Mechanical Turk. Measures assessed five decision-making styles, histories of suicide ideation and attempts, and several commonly cited correlates of suicide. Consistent with previous work, depression, anxiety, hopelessness, psychological pain, and belongingness were associated with suicidal ideation, but similar in individuals who made suicide attempts compared to individuals with suicidal ideation but no history of attempts. In contrast, a spontaneous decision-making style was moderately higher in individuals who made suicide attempts compared to individuals with suicidal ideation. To a lesser extent, borderline personality traits, some aspects of impulsivity, and a rational decision-making style also distinguished individuals who made suicide attempts from those with suicidal ideation. Findings can help inform suicide theory and prevention.

Wallace, M., et al. (2021). Empirically evaluated suicide prevention program approaches for older adults: A review of the literature from 2009-2021. Journal of Gerontological Social Work. DOI: 10.1080/01634372.2021.1907495  
This systematic review examined evaluated suicide prevention programs for older adults published between 2009 and 2021. 8 studies were identified looking at programs divided into the categories of primary and home health care, counselling, and community-based programs.

Abstract – Mental health in later life and suicide risk among older adults are important topics for social work. There is evidence-based research to support the use selective and indicated strategies for suicide prevention, yet, universal prevention approaches are also needed. However, the extent to which the broader contexts of suicide have been examined remains largely absent from the literature. This article presents findings from a systematic review of articles published between 2009 and 2021, focusing what types of empirically evaluated suicide prevention programs effectively prevent and reduce suicidality in older adults. Using the PICO and PRISMA guidelines, a final sample of 8 articles were reviewed in this systematic review. The articles were categorized into three types of programs: 1) primary and home health care, 2) community-based outreach, and 3) counseling. The articles also examined the involvement of social workers in these programs. Following a description of the articles, the authors assess each study using the GRADE rating system. Lastly, the authors discuss the role of the social worker in mental health promotion and prevention strategies.

Persett, P., et al. (2021). Higher suicide intent in patients attempting suicide with violent methods versus self-poisoning. Crisis. DOI: 10.1027/0227-5910/a000773.
It is generally assumed that individuals using more lethal or violent methods of suicide have a higher intent to die than those using self-poisoning as a method. To seek evidence of this assumption, the authors studied hospitalized patients who had attempted suicide using violent methods against those who had attempted through self-poisoning.

Abstract – Background: Suicidal intent for patients attempting suicide using violent methods (VMs) is assumed to be higher than for those using self-poisoning (SP), which may explain the higher mortality observed in follow-up studies. However, this has not been studied prospectively. Aims: We aimed to compare patients attempting suicide using VMs with those using SP regarding suicidal intent, suicidal ideation, depression, and hopelessness during hospital stay and after 1 year. Methods: Patients hospitalized after suicide attempt by VMs (n = 80) or SP (n = 81) completed the Beck scales for Suicide Intent, Suicide Ideation, Depression Inventory, and Hopelessness on admission and at the 12-month follow-up. Results: On admission, those using VMs had higher suicidal intent than those using SP (M = 16.2 vs. 13.3, p < .001), but lower depression scores (M = 22.2 vs. 26.8, p < .05). No significant differences were found in suicidal ideation (M = 20.1 vs. 23.1) or hopelessness (M = 10.1 vs. 11.9). At 12-month follow-up, depression scores decreased significantly for both groups, while hopelessness decreased only for the SP group. Limitations: The statistical power achieved was lower than intended. Conclusion: The higher levels of suicidal intent, but lower levels of depression, may indicate more impulsivity among people attempting suicide using VMs. Suicidal ideation was relatively stable.

🇨🇦 Montreuill, M., et al. (2021). Everyday ethics of suicide care: Survey of mental health care providers’ perspectives and support needs. PLOS One. DOI: 10.1371/journal.pone.0249048
This Canadian study surveyed the ethics of mental heath care providers in Quebec. Issues ranging from caring for suicidal patients and the perceived needs to address these issues were raised in the survey.

Abstract – Suicide occurs in people of all ages and backgrounds, which negatively affects families, communities, and the health care providers (HCPs) who care for them. The objective of this study was to better understand HCPs’ perspectives of everyday ethical issues related to caring for suicidal patients, and their perceived needs for training and/or support to address these issues. We conducted a mixed methods survey among HCPs working in mental health in Québec, Canada. Survey questions addressed their perspectives and experiences of everyday ethical challenges they encounter in their practice with people who are suicidal, and their perceived needs for training and/or support therein. 477 HCPs completed the survey. Most participants mentioned encountering ethical issues when caring for people who are suicidal. The challenges HCPs encounter in their practice with people who are suicidal are numerous, including issues related to maintaining privacy, confidentiality, freedom and the therapeutic relationship. The lack of time, resources and professional support to address these issues was emphasized. Most HCPs reported that the training or education they have received does not allow them to address everyday ethical issues related to suicide care. In sum, there is a clear reported need for better training and support for HCPs who are offering care to people who are suicidal in relation to everyday ethical issues they encounter. Implications for practice include providing greater access to training, including access to specialists in ethics to address specific issues. This additional support could alleviate morally distressing situations for HCPs.

🇨🇦 Genest, C., et al. (2021). Correctional work: Reflections regarding suicide. International Journal of Environmental Research and Public Health, 18(8). DOI: 10.3390/ijerph18084280
A study of suicidality amongst Canadian correctional workers.

Abstract – The Public Health Agency of Canada declared suicide a public health problem in Canada (2016). Employees working in correctional services, researchers find, experience high rates of lifetime suicidal ideation in comparison to other public safety professionals and the general population. Suicide behaviours (i.e., ideation, planning, attempts, death) are a multifactorial phenomenon, explained in part by the Interpersonal-Psychological Theory of Suicide that suggests attempted suicide is facilitated by perceived burdensomeness, a lost sense of belonging, a feeling of hopelessness, and a progressively reduced fear of death, as well as capacity and planning to engage a lethal attempt. In the current study, we unpack the factors that can influence suicide behaviours as reported by correctional workers. Our intent is to make explicit the experiences of a small sample (n = 25) of correctional workers in relation to suicidal behaviours, highlighting stories of recovery and acknowledging the importance of facilitating psychologically safe workplaces. Analysis entailed an inductive semi-grounded emergent theme approach. Participants identified certain risk factors as being able to induce suicidal ideation, such as marital or family problems as well as difficulties at work (i.e., bullying or difficult working conditions). Having children and a partner may act as factors preventing suicide for those with ideation. Participants sought help from professionals, such as their family doctor, a psychologist, or the Employee Assistance Program (EAP); however, the lack of perceived organizational supports and recognition of the issue of suicide by the employer are two elements that can hinder the search for help.

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