This is a summary of the latest significant Canadian () and international suicide research we collected in the past month:
🇨🇦 Oliffe, J., et al. (2020). Help-seeking prior to male suicide: Bereaved men perspectives. Social Science & Medicine. DOI: https://doi.org/10.1016/j.socscimed.2020.113173
This Canadian study examines the help-seeking behaviours of men who have died by suicide by gathering the insights of other males bereaved by their deaths. A qualitative method, photovoice, is employed in the research.
Abstract – Male suicide is a significant issue globally, and implicated are men’s challenges around help-seeking and engagement with peer or professional mental health care. While men’s reticence for help-seeking predominates as an explanatory gendered dimension for male suicide, there are significant caveats and complexities to fully understanding those practices in the context of men’s mental illness and suicidality. The current photo-voice study offers considerable insight into such issues – through the eyes of the bereaved – retrospectively exploring accounts of the deceased’s mental health help-seeking prior to the death. Using an interpretive design, and based on semi-structured individual photo-elicitation interviews with 20 men who had lost a male friend, family member or partner to suicide, three key dimensions were identified: 1) Entrapped by secrecy and concealing the need for help, in which the deceased hid their suicide risk and need for peer or professional mental health care; 2) Overwhelming illness that couldn’t be helped, wherein the deceased had previously connected with an array of social supports and medical services but was estranged from peer and professional help ahead of the suicide, and 3) Services and systems providing ineffectual help, whereby the deceased was connected with mental health care shortly before the suicide. These themes reveal complex relations to help, and help-seeking in men lost to suicide, as well as bereaved men’s reliance on normative masculinities as an explanatory framing of these practices. Discussed within a critical masculinities framework, the current study highlights the need to destigmatize men’s mental illness and help-seeking as well as address significant health inequities to aid the efficiencies of men’s suicide prevention programs.
Schlichthorst, M. (2020) Lived experience peer support programs for suicide prevention: A systemic scoping review. International Journal of Mental Health Systems. DOI:https://doi.org/10.1186/s13033-020-00396-1
There is a lack of research examining the efficacy of peers support programs in suicide prevention, however this scoping review looks at 7 such peer-led programs have been studied.
Abstract – Background: Peer-led support models have gained increasing popularity in suicide prevention. While previous reviews show positive effects of peer-led support for people with mental health problems and those bereaved by suicide, little is known about the types of lived experience peer support programs in suicide prevention and whether these are effective in improving the health and wellbeing of people at risk of suicide. The aim of this paper is to provide an overview of peer support programs that aim to reduce suicidality and are led by people with lived experience of suicide. Method: We conducted a systematic scoping review, involving a search of three academic (Medline, PsycINFO, Embase) and selected grey literature databases (Google Scholar, WHO Clinical Trials Registry) for publications between 2000 and 2019. We also contacted suicide prevention experts and relevant internet sites to identify peer support programs that exist but have not been evaluated. The screening of records followed a systematic two-stage process in alignment with PRISMA guidelines. Results: We identified 8 records accounting for 7 programs focused on peer-led support programs in suicide prevention. These programs employed a range of different designs and included a variety of settings (schools, communities, rural and online). Only 3 of the 7 programs contained data on effectiveness. With the small number of eligible programs the findings from this review are limited and must be interpreted with caution. Conclusions: Despite the increased focus of policymakers on the importance of peer support programs in suicide prevention, our scoping review confirms an evidence gap in research knowledge regarding program design, implementation, and effectiveness. More rigour is required in reporting peer-led support initiatives to clarify the underlying definition of peer support and lived experience and to enhance our understanding of the types of current peer support programs available to those experiencing suicidality. Further, we need formal and high-quality evaluations of peer support suicide prevention programs led by people with lived experience to better understand their effectiveness on participant health across different settings and delivery modalities and to allow for comprehensive systematic reviews and meta-analysis in future.
Amiri, S. (2020). Prevalence of suicide in immigrants/refugees: A systematic review and meta-analyses. Archives of Suicide Research. DOI: https://doi.org/10.1080/13811118.2020.1802379
A systematic review looking at 51 studies to determine the prevalence of suicide in the immigrant and refugee population groups.
Abstract – Objective: In recent years, there has been an increase in immigrant populations worldwide. This study aims to present the global prevalence of suicide between immigrants and refugees as well as to report the prevalence of suicide ideation, suicide mortality, suicide attempts, and plan of suicide. Method: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA’s) rules were used as a guide in the current research path. PubMed and EMBASE were targeted for the study until December 2019. After collecting the data, the number of events and sample size extracted for each study and also pooled odds ratio and confidence interval (CI) were used to investigate the suicide ratio among immigrants and refugees compared to the native population. Results: Fifty-one studies were included in the meta-analysis to investigate suicide prevalence or suicide odds ratio. The prevalence of suicidal ideation was 16% (CI: 0.12–0.20, I 2 = 99.4%), for attempted suicide was 6% (CI: 0.05–0.08, I 2 = 98.0%), and for suicide plan prevalence was 4% (CI: 0.00–0.08, I 2 = 96.8%). The prevalence of suicidal ideation was 10% (CI: 0.04–0.17, I 2 = 0.0%) in men and 17% (CI: 0.10–0.24, I 2 = 96.8%) in women. The prevalence of attempted suicide was 1% (CI: 0.01–0.02, I 2 = 0.0%) in men and 7% (CI: 0.03–0.10, I 2 = 94.4%) in women. The odds ratio of suicide mortality among immigrants was 0.91 (CI: 0.90–0.93, p < 0.001; I 2 = 97.6%) and for attempted suicide was 1.15 (CI: 1.10–1.20, p < 0.001; I 2 = 92.0%). Begg’s test (p = 0.933) (Egger test; p = 0.936) rejected publication bias. Conclusion: Given the high prevalence of suicide, especially suicide ideation and suicide attempts in immigrants, increased attention needs to be paid to the mental health of this population.
Nelson. P & Adams, S. (2020). Role of primary care in suicide prevention during the COVID-19 pandemic. The Journal for Nurse Practitioners. DOI: https://doi.org/10.1016/j.nurpra.2020.07.015
The majority of people who die by suicide have seen their primary health care provider in the prior year. This study stresses the need for suicide prevention education in a primary care setting and the special importance of screening tools in the identification of those potentially at risk of suicide.
Abstract – Primary care providers have an important role in suicide prevention, knowing that among people who die by suicide, 83% have visited a primary care provider in the prior year, and 50% have visited that provider within 30 days of their death, rather than a psychiatrist. The psychosocial impact of the coronavirus disease 2019 pandemic poses increased risk for suicide and other mental health disorders for months and years ahead. This article focuses on screening tools, identification of the potentially suicidal patient in the primary care setting, and a specific focus on suicide prevention during widespread, devastating events, such as a pandemic.
Duncan, S. (2020). Teaching responsible suicide reporting (RSR): Using storytelling as a pedagogy to advance media reporting of suicide. Journalism Education, 9(1),18-31.
Most papers on media reportage on suicide focus on the guidelines that should be undertaken to avoid contagion. This report goes beyond by proposing a Responsible Suicide Reporting Model (RSR) which offers differing narrative types and the storytelling approaches that journalists may adopt to effectively report on suicide. It is believed that this approach will be more effective in teaching proper suicide reportage to students. The model is tested in the United Kingdom and Ireland among journalism students in 2 groups (exposure and non-exposure to the RSR model).
Abstract – Reporting suicide is an important but challenging area of journalism practice. Learning how to report this complex, distressing subject is vital for journalists if they are to avoid contributing to the 800,000 annual suicidal deaths worldwide (WHO, 2019). Tuition on suicide reporting in higher education tends to be didactic and theoretical, focussing on media guidelines and codes of conduct. Thereafter, journalists’ ability to implement this guidance is mixed. To address this, the authors devised the Responsible Suicide Reporting Model (RSR) which is grounded in news-work and embeds media guidelines within journalistic storytelling, consisting of a typology of suicide narratives and ‘othering’, ethical rules and a standard of moderation. This study tests the effectiveness of teaching the RSR Model using storytelling-as-pedagogy. and problem-based learning. Firstly, we investigated students’ perspectives on current educational offerings on suicide reporting through a survey of 229 students in the UK and Ireland who had no exposure to the RSR model. We then ran workshops with 80 students in the UK, teaching them the RSR model. The results showed that students with no exposure to the model–while they seemed to be aware of the theory of responsible suicide reporting–did not know how to implement it. Students who participated in workshops, where the RSR model was used, reported a greater understanding of responsible suicide reporting, believing they became better critically reflective practitioners.
Gwyther, K., et al. (2020). Taking youth suicide prevention to the schools: Pilot evaluation of school-based clinician outcomes and perspectives of a multi-modal program including post-training online consultations for management of ongoing suicide risk. Psychiatry International, (1), 9-23; https://doi.org/10.3390/psychiatryint1010002
An evaluation of a school-based suicide prevention program delivered to school-based social workers in Tasmania, Australia.
Abstract – School-based youth-specific suicide prevention and early intervention initiatives are presently underdeveloped. The current study conducted a pilot evaluation of a multi-modal suicide prevention training program for school-based social workers, ‘Management of Youth Suicidality Training for Schools’ (MYSTS). The program comprised a two-day workshop and six fortnightly post-workshop webinar online consultations. Participants were 36 social workers (years’ experience M = 11.23, SD = 8.29) employed by the Department of Education in Tasmania, Australia. Outcomes were self-rated confidence, competence, and knowledge of self-harm in young people, and attitudes toward suicide prevention and suicide-related behaviors. Exploratory quantitative results indicated significant improvements with large effect sizes for participants’ self-reported competence (d = 1.33), and confidence (d = 1.29) to identify and respond therapeutically to youth suicidality following the workshop. Confidence remained significantly higher than baseline following the online consultations (d = 0.90). Qualitative analysis of online supervision consultations indicated key themes of accessibility, communication and information sharing, and clinical management. Participants endorsed the MYSTS package as well-presented, with relevant topics, and effective learning activities. This study highlights the need for continued supervisory or implementation support to practitioners following suicide prevention training initiatives and suggests web-based teleconference technology as a feasible strategy for this. Further evaluation of the MYSTS package, including a suitable comparison or control condition, is indicated.
Panesar, B., et al. (2020). National suicide management guidelines with family as an intervention and suicide mortality rates: a systematic review protocol. BMJ Open 2020;10:e034694. doi:10.1136/ bmjopen-2019-034694
A proposal for a systematic review protocol, including search strategies and review guidelines, exploring family-based interventions and their effects on national suicide mortality rates.
Abstract – Introduction Suicidal behaviour remains a major public health challenge worldwide. Several countries have developed national suicide guidelines aimed at raising awareness of and preventing deaths by suicide. One of the interventions often mentioned in these national guidelines is the involvement of family members as a protective factor in suicide prevention. However, the level or type of family involvement required to reduce suicidal behaviour is not well understood. Thus, in this systematic review, we seek to determine the effectiveness of family-based interventions as a suicide prevention tool, by comparing suicide mortality rates between countries whose national suicide prevention guidelines include family-based interventions and those whose do not. Methods and analysis MEDLINE, EMBASE, PsycINFO, Web of Science and WHO MiNDbank databases as well as grey literature such as National Guideline Clearinghouse will be searched. National guidelines for suicide prevention published within the last 20 years (between 1999 and 2019) will be included. Results will be analysed using thematic and qualitative analyses. Ethics and dissemination The findings of the study will help improve the efficacy of national suicide prevention strategies. Findings will be disseminated using easily accessible summary reports and resources to primary end users.
Adrian, M., et al. (2020). Implementation determinants and outcomes of a technology-enabled service targeting suicide risk in high schools: Mixed methods study. Journal of Medical Internet Research Mental Health. 7(7), e16338) doi: 10.2196/16338
In this study, qualitative and quantitative methods were employed to look at a technology-enabled service(TES) among students(11) and educators(9) in a high school setting. An objective of TESs( augmenting human services with digital components) is to “increase the reach and impact of mental health interventions”.
Abstract – Background: Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential. Objective: This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting. Methods: A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES. Results: Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care. Conclusions: Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.
Halford, E.A., et al. (2020). Google searches for suicide and suicide risk factors in the early stages of the COVID-19 pandemic. PLoS ONE 15(7): e0236777. https://doi.org/ 10.1371/journal.pone.0236777
The authors looked at Google Trends and searches conducted relating to suicide in the early stages of the COVID-19 pandemic to determine if there has been an increase in current risk factors which could result in increases in suicide in the long-term.
Abstract – A novel coronavirus (SARS-CoV-2), which causes the COVID-19 respiratory illness, emerged in December of 2019 and has since spread globally. The dramatic lifestyle changes and stressors associated with this pandemic pose a threat to mental health and have the potential to exacerbate risk factors for suicide. We used autoregressive integrated moving average (ARIMA) models to assess Google Trends data representing searches in the United States for 18 terms related to suicide and known suicide risk factors following the emergence of COVID-19. Although the relative proportion of Google searches for suicide related queries was lower than predicted during the early pandemic period, searches for the following queries representative of financial difficulty were dramatically elevated: “I lost my job” (226%; 95%CI, 120%-333%), “laid off” (1164%; 95%CI, 395%-1932%), “unemployment” (1238%; 95%CI, 560%-1915%), and “furlough” (5717%; 95%CI, 2769%-8665%). Searches for the Disaster Distress Helpline, which was promoted as a source of help for those impacted by COVID-19, were also remarkably elevated (3021%; 95%CI, 873%- 5169%). Google searches for other queries representative of help-seeking and general mental health concerns were moderately elevated. It appears that some indices of suicidality have fallen in the United States in this early stage of the pandemic, but that COVID-19 may have caused an increase in suicide risk factors that could yield long-term increases in suicidality and suicide rates.
Stiawa, M., et al. (2020). Mental health professionals view about the impact of male gender for the treatment of men with depression: A qualitative study. BMC Psychiatry (2020) 20:276 https://doi.org/10.1186/s12888-020-02686-x
A qualitative study of mental health professionals and their attitudes toward male gender. There is a need for treatment and services for men with depression with a gender-specific emphasis.
Abstract – Background: The underestimation of depression among men may result from atypical depression symptoms and male help-seeking behaviour. However, higher suicide rates among men than among women indicate a need for gender-specific services for men with depression. In order to develop gender-specific services, it is essential to examine professionals’ attitudes towards men’s depressive symptoms and treatment needs as well as barriers to and facilitators of treatment. This study examined gender-specific treatment needs in male patients and treatment approaches to male patients from a professional perspective. Methods: Semi-structured face-to-face interviews were conducted with 33 mental health professionals (MHPs) from five German psychiatric institutions. The study assessed the characteristics and attributes of male patients with depression risk factors for the development of depression among men, their condition at the beginning of treatment, male patients’ depressive symptoms, the needs and expectations of male patients, the importance of social networks in a mental health context, and MHPs’ treatment aims and treatment methods. Transcripts were analysed using qualitative content analysis. Results: The professionals’ reference group of male patients were men who were characterised in accordance with traditional masculinity. Attributes reported as in line with this type of men were late initiations of inpatient treatment after crisis, suicidal ideation or attempted suicide, and high expectations towards treatment duration, success rate in recovery and therapeutic sessions. In contrast, male patients who deviate from these patterns were partially described with reference to female stereotypes. Professionals referred to psychosocial models in their explanations of the causes of depression and provided sociological explanations for the development of masculine ideals among men. The consequences of these for treatment were discussed against the background of normative expectations regarding the male gender. From the professionals’ point of view, psychoeducation and the acceptance of depression (as a widespread mental illness) were the most important goals in mental health treatment. Conclusions: In order to improve mental health among men, gender-specific services should be offered. Awareness of the role of gender and its implications on mental health treatment should be an integral part of MHPs’ education and their daily implementation of mental health treatment practices.
🇨🇦 Saewyc, E.M., et al. (2020). The link between LGBTQ-supportive communities, progressive political climate, and suicidality among sexual minority adolescents in Canada. Preventive Medicine. 139, October 2020, 106191. doi.org/10.1016/j.ypmed.2020.106191
Data from the 2013 British Columbia Adolescent Health Survey were used to determine whether community resources supporting LGBTQ populations had an affect on suicidal ideation and self- harming behaviours among sexual minority adolescents.
Abstract – Despite supportive structural changes to reduce stigma towards lesbian, gay, and bisexual, transgender, queer, and questioning (LGBTQ) Canadian residents, sexual minority youth still face disparities compared to heterosexual peers. We aimed to characterize LGBTQ-supportive environments and political climates, and examine their links to suicidal behavior among sexual minority adolescents in western Canada. Data were from the 2013 British Columbia Adolescent Health Survey, a cluster-stratified random cross-sectional survey of public school students in BC, Canada; We sampled 2678 self-identified LGB and mostly heterosexual students (69% girls) from 274 schools, representing an estimated provincial population of 24,624 sexual minority students in weighted models. Student reports of past-year suicidal ideation, suicidal attempts, and self-harm behaviors were merged with community-level data assessing diverse aspects of LGBTQ-supportive resources and progressive political climates in communities surrounding the schools. Adjusted multilevel models showed that for sexual minority adolescent girls, higher community LGBTQ-supportiveness predicted marginally significant lower suicidal ideation (aOR = 0.94, 95% CI [0.88, 1.01]) and suicidal attempts (aOR = 0.91, 95% CI [0.83, 1.00]) and significantly lower self-harm behaviors (aOR = 0.91, 95% CI [0.85, 0.98]). Further, progressive political climates predicted marginally significant lower suicidal ideation (aOR = 0.89, 95% CI [0.78, 1.02]) and significantly lower self-harm behaviors (aOR = 0.87, 95% CI [0.77, 0.99]). For sexual minority adolescent boys, no community-level variables were associated with suicidal behavior in adjusted models. Thus, LGBTQ-supportive communities and progressive political climates appear to be protective against suicidal behavior among sexual minority adolescent girls, but not sexual minority adolescent boys.