Research Roundup – April 2024
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This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month.
Rowe, S. & Ansloos, J. P. (2024). Understanding suicide from an Indigenous cultural lens: Insights from Elders in Canada. Journal of Religion and Health.
https://doi.org/10.1007/s10943-024-02022-7
An Indigenous cultural lens toward suicide prevention was emphasized in this qualitative study of Indigenous elders and their perceptions on suicide.
Abstract – In this study, Indigenous Elders in Canada were interviewed to explore their conceptualizations of death and dying, particularly in relation to suicide. Through reflexive thematic analysis, three key themes were developed: Indigenous conceptions of death and dying, Christian influences on views of suicide, and indirect suicide. The theme of Indigenous conceptualizations of death and dying included the subthemes of spirituality and life after death, highlighting the importance of spiritual beliefs in Indigenous culture and knowledge systems. The impact of Christian influences on views of suicide was also explored, with participants discussing the complex nature of the relationship between Christianity and Indigenous peoples. Finally, the theme of indirect suicide was analyzed, referring to deaths resulting from behaviors that do not necessarily fit within the conventional definition of suicide. Overall, this study highlights the importance of honoring Indigenous cultural knowledge in research related to suicide prevention in Indigenous communities.
Cote, L. P. & Lane, J. (2024). Evaluation of the effectiveness of suicide.ca., Quebec’s digital suicide prevention strategy platform: Cross-sectional descriptive study. JMIR Formative Research.
https://doi.org/10.2196/46195
In 2017, Association québécoise de prévention du suicide (AQPS) launched a digital suicide prevention strategy (DSPS) called suicide.ca. It is a website that “provides information on suicide and mental health, identifies at-risk individuals on the internet, and offers direct crisis intervention support via chat and text”. This is a study of its effectiveness.
Abstract – Background: In 2017, the Quebec government assigned the Association québécoise de prévention du suicide (AQPS) to develop a digital suicide prevention strategy (DSPS). The AQPS responded by creating a centralized website that provides information on suicide and mental health, identifies at-risk individuals on the internet, and offers direct crisis intervention support via chat and text. Objective: This study aims to evaluate the effectiveness of suicide.ca, Quebec’s DSPS platform. Methods: This study used a cross-sectional descriptive design. The study population comprised internet users from Quebec, Canada, who visited the suicide.ca platform between October 2020 and October 2021. Various data sources, such as Google Analytics, Firebase Console, and Customer Relation Management data, were analyzed to document the use of the platform. To understand the profile of suicide.ca users, frequency analyses were conducted using data from the self-assessment module questionnaires, the intervention service’s triage questionnaire, and the counselors’ intervention reports. The effectiveness of the platform’s promotional activities on social media was assessed by examining traffic peaks. Google Analytics was used to evaluate the effectiveness of AQPS’ strategy for identifying at-risk internet users. The impact of the intervention service was evaluated through an analysis of counselors’ intervention reports and postintervention survey results. Results: The platform received traffic from a diverse range of sources, with promotional efforts on social media directly contributing to the increased traffic. The requirement of a user account posed a barrier to the use of the mobile app, and a triage question that involved personal information led to a substantial number of dropouts during the intervention service triage. AdWords campaigns and fact sheets addressing suicide risk factors played a crucial role in driving traffic to the platform. With regard to the profile of suicide.ca users, the findings revealed that the platform engaged individuals with diverse levels of suicidal risk. Notably, users of the chat service displayed a higher suicide risk than those who used the self-assessment module. Crisis chat counselors reported a positive impact on approximately half of the contacts, and overall, intervention service users expressed satisfaction with the support they received. Conclusions: A centralized digital platform can be used to implement a DSPS, effectively reaching the general population, individuals with risk factors for suicide, and those facing suicidal issues.
Pritchard, T. R., Buckle, J. L., Thomassin, K. & Lewis, S. P. (2024). Rural suicide: A systematic review and recommendations. Clinical Psychological Science. https://doi.org/10.1177/21677026241234319
This is a systematic review of 142 studies examining the multiple facets of rural suicide.
Abstract – Suicide is a public-health concern that has been linked to multiple biological, psychological, and social risk factors. Rural living is purported to be a unique risk for suicide for myriad reasons. Yet there are some concerns with rural suicidology, notably regarding defining and operationalizing “rural.” Furthermore, the last comprehensive review of rural suicide is approximately 10 years old. With this in mind, in the current review, we offer (a) a comprehensive and updated overview of the operationalization and variability of rural in rural suicidology and (b) a summary of differences in direct and indirect suicide factors between rural and nonrural regions and whether potential differences depend on how rural is operationalized. Results indicate a high degree of heterogeneity in defining rural, rendering conclusions about both direct and indirect rural suicide risks unclear. We therefore present a set of recommendations for rural suicidologists to apply to enhance the understanding of suicide and, ultimately, prevent death by suicide in rural regions.
Awaad, R. et al. (2024). The development and implementation of a custom-tailored suicide response training for Muslim communities. Journal of Religion and Health. https://doi.org/10.1007/s10943-024-02032-5
This is a paper describing the creation of the Muslim Community Suicide Response Manual by the Stanford Muslim Mental Health and Islamic Psychology Lab at Stanford University in California.
Abstract – Research indicates that the suicide attempt rate among American Muslims is at least twice the rate of the national US average and follows a different trend of suicide behavior compared to other groups. Religious leaders, such as Imams, are commonly sought out for support, but many lack training in mental health crisis management. The Stanford Muslim Mental Health and Islamic Psychology Lab created the Muslim Community Suicide Response Manual and its accompanying training modules to address this issue. This paper describes the creation, evolution, and future directions of the Suicide Response Training from an Islamic perspective to reduce suicide risk in Muslim communities.
Turnbull, P. et al. (2024). Can real-time surveillance systems of suspected suicide accurately reflect national suicide rates? Age-specific and sex-specific findings from the first two years of the COVID-19 pandemic in England: An observational study. BMJ Public Health.
https://doi.org/10.1136/bmjph-2023-000670
Data from real-time surveillance (RTS) systems in England were used to measure instances of suicide in the early months of the COVID-19 pandemic. These numbers were later compared with official suicide statistics for validity and viability.
Abstract – Introduction: ‘Real-time surveillance’ (RTS) systems of suspected suicide showed no overall rise in the early COVID-19 pandemic several months before official statistics reported the same. There has to date been no national examination of suicide recorded by RTS systems by sex or age group during the COVID-19 pandemic. Methods: We used data from established RTS systems of suspected suicides in England, in 10 areas covering a total population ~13million, to examine overall suicide numbers and rates from the pre-pandemic months of January– March 2020, to the end of 2021, by sex and by age group, through different phases of the pandemic. Results: From January 2020 to December 2021, there were 2923 suspected suicides recorded by RTS systems in the 10 areas providing data. Using the pre-pandemic period as the baseline, we found a lower rate of suicide in the remainder of 2020 compared with the pre-pandemic period (0.80–0.99). This fall reflected lower numbers of deaths in men aged 25–44 between April and December 2020. Though there was no significant fall in 2021, there were lower rates in people aged 45–64 during this time. A month-by-month breakdown showed no change during periods of lockdown or social restrictions. Conclusions: Our findings demonstrate the viability of RTS to provide timely information on suicide rates at a national level and were later confirmed by official statistics. While suicide rates have not increased, continued vigilance is needed given ongoing effects of the pandemic in the context of current economic pressures. Early data on suspected suicides collected by local systems can be instrumental in reflecting national trends, and in aiding a rapid response in times of crisis.
Genuchi, M. C. (2024). Broadening the perspective on the dynamics of men’s suicide: Thought suppression as a mediator between men’s self-reliance and suicidality. Archives of Suicide Research. 28(1), 324–341.
https://doi.org/10.1080/13811118.2023.2173114
785 men were surveyed in this study which examined associations between particular masculine gender norms and the suppression of distressing thoughts. By extension, thought suppression was analyzed for an increased risk for suicidal thoughts and behaviours.
Abstract – Objective: In most countries, men are at higher risk than women for suicide death. Research focused on masculinity and men’s mental health increasingly demonstrates that relationships between gender and various health outcomes, including suicidality, is complex as these relationships can be further explained by certain psychological processes or health behaviors. The objective of this study was to extend this area of research in a national sample of US men (n = 785) by investigating if their adherence to certain hegemonic masculine gender role norms (toughness and self-reliance through mechanical skills) is associated with the suppression of distressing thoughts and if thought suppression then increases their risk for suicidal thoughts and behaviors. Methods: Men in the US who have recently experienced a stressful life event completed an anonymous online survey. Structural Equational Modeling (SEM) was used to test for direct and indirect effects (i.e., mediation) between variables. Results: Men’s engagement in thought suppression mediated the relationship between self-reliance and suicidality. The norm of toughness was both directly related to suicidality and mediated by thought suppression. Conclusions: Thought suppression appears to be a process that provides some explanation for the relationships between hegemonic masculine norms and suicidality in men, though this study indicated it may play only a small role. Research continues to build that certain masculine norms, such as self-reliance and toughness, are particularly concerning for men’s health.
Heesen, K. et al. (2024). The forever decision: A qualitative study among survivors of a suicide attempt. eClinicalMedicine, 69, 102449.
https://doi.org/10.1016/j.eclinm.2024.102449
27 adults (23 women and 4 men) who had attempted suicide within the previous year were interviewed to analyze each individual’s suicide trajectory.
Abstract – Background: Suicide attempts have a profound emotional impact on both individuals and society as a whole. This qualitative study delves into three key aspects: 1) the progression through the suicidal process, 2) the influential factors facilitating the transition from ideation to attempt using the volitional moderators within the integrated motivational-volitional (IMV) model, and 3) preventive strategies impeding this transition from ideation to attempt. Methods: Between October 1, 2022 and March 7, 2023 we interviewed 27 adults (23 women, four men, mean age 33 years) who attempted suicide within the past 12 months. Participants were recruited through social media and in collaboration with several mental health institutions in the Netherlands. The participants were initially screened and interviewed based on the Pathway to Suicidal Actions Interview. Analysis was performed employing the constant comparative method. Findings: Despite the heterogeneity of the suicidal process, suicidal thoughts predominately emerged during adolescence (Mdn = 15, M = 17.8). In most participants, planning and preparatory actions occurred long before the attempt, with a median of six years prior to the attempt for the selection of the method. All volitional moderators were observed, although pain sensitivity in particular varied among participants. Access to lethal means and planning emerged as important moderators in the suicidal process. Asking the survivors what could have helped to prevent their attempts, most participants mentioned that they felt their suicidality was not taken seriously enough. Interpretation: We discussed the significance of planning in the suicidal process, challenges in conceptualizing planning and impulsivity, and individual differences in pain sensitivity. Based on the findings, we underscore the critical need for restricting access to means, giving greater consideration to preparatory actions within the suicidal process, and fostering open dialogues about suicidality.
Jha, S. et al. (2024). Can your Smartphone save a life? A systematic review of mobile-based interventions for suicide prevention. International Journal of Human–Computer Interaction.
https://doi.org/10.1080/10447318.2024.2323274
80 suicide prevention apps were reviewed for “persuasive strategies”, using the Persuasive System Design (PSD) model. They also analyzed the effectiveness, evaluative methods, and content for each app.
Abstract – Mobile health (mHealth) apps are handy tools for tackling stigmatized mental health issues, including suicide. Mobile-based interventions for suicide prevention are easily accessible, increase the likelihood of honest reporting on sensitive topics and reduce stigma as compared to face-to-face or traditional interventions. Many mHealth apps for suicide prevention exist. However, the persuasive strategies employed in these apps and their efficacy remains unknown. To address this gap, we reviewed 80 suicide prevention apps available on app stores and in academic journals. We identified different persuasive strategies implemented in these apps using the Persuasive System Design (PSD) model. We also identified current trends within these apps, most and least-dominant implementations of persuasive strategies, effectiveness of apps, evaluation methods, and app content. We found that Personalization (n = 32) and Self-monitoring (n = 29) were the most-dominant strategies and Social Comparison, Social Role were the least-dominant strategies in suicide prevention apps. Based on our findings we discuss three major concerns in developing suicide prevention apps and offer recommendations for mitigating them. Our results show that persuasive strategies are a promising tool that can be used for designing suicide prevention apps. Our conclusions and recommendations will guide future work in suicide prevention app development and enhance the usability, effectiveness, and user-experience of such apps.
Bertuccio, P. et al. (2024). Global trends in youth suicide from 1990 to 2020: An analysis of data from the WHO mortality database. eClinicalMedicine.
https://doi.org/10.1016/j.eclinm.2024.102506
In this paper, data from the World Health Organization mortality database were used to analyze youth suicide, globally, from 1990 to 2020.
Abstract – Background: Suicide is a serious but preventable public health concern at the global level, showing relevant geographical differences. This study aims to monitor global temporal and geographical patterns in suicide mortality in pre-adolescents, adolescents, and young adults (i.e., aged 10–24 years), from 1990 to 2020 or the most recent available year. Methods: Using the World Health Organisation mortality database, we conducted an analysis on a subset of 52 countries with valid and high-quality data. We computed age-standardised suicide rates (ASR) by sex, country, and calendar year, and performed a joinpoint regression analysis to identify significant changes in the temporal suicide trends over the studied period. Findings: High variability in suicide rates and trends was observed, with a male-to-female ratio of two to five. Between 1990 and 2020, most European countries reported declining suicide trends, with some exceptions. In particular, alarming trends emerged in the United Kingdom, with annual rises of 2.5% (95% CI: 1.6–3.5) since 2005 among males and 8.5% (95% CI: 4.7–12.6) since 2012 among females. The most favorable trends and lowest suicide rates were in Southern Europe, with 3.1/100,000 persons in Italy (2020) and 3.5/100,000 persons in Spain (2021) among males, and 0.9/100,000 persons in Italy (2020) and 1.1/100,000 persons in Romania (2019) among females. Conversely, the highest rates were in Central-Eastern Europe, with 10.2/100,000 males in the Russian Federation (2019) and 10.0/100,000 males in Poland (2002). Higher suicide rates and significant increases were reported in not European areas. The highest ASR was 15.5/100,000 males in the United States of America, with an annual increase of 3.8% (95% CI: 3.1–4.5) among males in 2009–2020 and 6.7% (95% CI: 5.6–7.8) among females in 2007–2017, followed by a levelling off.
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