Research Roundup – August 2022
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month:
Wiglesworth, A., LittleDove, R., Fetter, A., Prairie Chicken, M., Azarani, M., Davis, A., Young, A., Riegelman, A. & Gone, J. (2022). Attempted suicide in American Indian and Alaska Native populations: A systematic review of research on protective factors. Clinical Psychology: Science and Practice. DOI: 10.1037/cps0000085
This systematic review looks at studies of protective factors in the prevention of suicide in American Indigenous populations.
Abstract – American Indian and Alaska Native (AIAN) populations contend with disproportionately high rates of suicide. The study of protective factors is essential for highlighting resilience and formulating potential interventions for suicide. We systematically review factors that are posited to protect against suicide attempts for AIAN peoples. Seventeen (12 journal articles, five theses/dissertations) articles met inclusion criteria. Results indicate that protective factors are typically situated at one of four levels of analysis: individual (e.g., self-esteem), family (e.g., parent caring), community (e.g., positive adult relationships), and cultural (e.g., cultural spiritual orientation). Notably, there were trends in protective factors across age, sex, and geographic region. Based on these findings, we propose recommendations for moving the field forward in future identification of protective factors as a means of AIAN suicide prevention.
Claveria, O. (2022). Global economic uncertainty and suicide: Worldwide evidence. Social Science & Medicine. DOI: 10.1016/j.socscimed.2022.115041
This is a study looking at suicide rates in 183 countries from 2000 to 2019. The authors look at unemployment, economic growth, and economic uncertainty and their impacts on the suicide rates.
Abstract – Economic uncertainty is a driver of the business cycle. In a recent study, Claveria (2022) used a fixed-effects model to assess the impact of uncertainty on suicide rates worldwide. Using that same panel, in which global economic uncertainty is linked to the evolution of the suicide rates in 183 countries between 2000 and 2019, this work evaluates the dynamic interconnections between unemployment, economic growth, uncertainty and suicide using a dynamic panel model. Overall, the analysis suggests that increases in the growth of economic uncertainty and unemployment may lead to increases in suicide rates growth worldwide. When replicating the experiment for different regions and for groups of countries classified according to their level of income, the greatest impact of increases in economic uncertainty is found in upper middle-income economies. Given the anticipatory nature of economic uncertainty with respect to the evolution of the economy, and its relationship with suicide rates, the obtained results suggest the usefulness of uncertainty indicators as tools for the early detection of periods of increased suicide risk and for the design of suicide prevention strategies.
Ingram, J., Lyford, B., McAtamney, A. & Fitzpatrick, S. (2022). Preventing suicide in refugees and asylum seekers: A rapid literature review examining the role of suicide prevention training for health and support staff. International Journal of Mental Health Systems. DOI: 10.1186/s13033-022-0
The authors looked at 14 studies examining gatekeeper training among refugee and asylum seeker populations. The studies covered the years 2000 to 2022.
Abstract – Background: Refugees and asylum seekers are exposed to a unique set of circumstances and experiences that are associated with an increased suicide risk. Suicide prevention training has been recognised as a central component supporting a comprehensive approach to suicide prevention. Limited literature exists exploring the role of suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Methods: To determine the impact suicide prevention training for health staff may have in supporting refugee and asylum seeker suicide prevention, researchers undertook a rapid literature review exploring what elements should be considered when developing suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Results: Results of academic and grey literature screening identified 14 studies exploring suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Findings of the literature review suggest suicide prevention training for health and support staff working with refugee and asylum seekers should consider the inclusion of content which increases participant competence and confidence to identify and respond to suicide risk; provide staff with an understanding of cultural differences and its impact on refugees and asylum seekers recognition of mental health and suicide as a health matter; highlight the importance trauma informed practices in care and consider the lived experience of refugees and asylum seekers. Conclusions: Inclusion of specific content in refugee and asylum seeker suicide prevention training may provide health and support staff increased competence and confidence to identify and respond to suicide risk in refugees and asylum seekers.
Arnon, S., Brunstein, A., Visoki, E., Moore, T., Argabright, S., DiDomenico, G., Benton, T. & Barzilay, R. (2022). Association of cyberbullying experiences and perpetration with suicidality in early adolescence. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2022.18746
A study of the relationship between the experience of cyberbullying and suicide among adolescents.
Abstract – Importance: Adolescent suicidality (ie, suicidal ideation or attempts) is a major public health concern. Cyberbullying experiences and perpetration have become increasingly prevalent and are associated with mental health burden, but their roles as independent suicidality risk factors remain unclear. Data are needed to clarify their contribution to teen suicidality to inform suicide prevention efforts. Objective: To examine whether cyberbullying experiences and perpetration are distinct stressors divergent from other forms of peer aggression experiences in their association with suicidality in early adolescence. Design, Setting, and Participants: This cross-sectional analysis used data collected between July 2018 and January 2021 from the Adolescent Brain Cognitive Development (ABCD) study, a large, diverse sample of US children aged 10 to 13 years. Exposures: Youth reports of cyberbullying experiences or perpetration. Main Outcomes and Measures: The main outcome was youth-reported suicidality (past or present, as reported in the ABCD 2-year follow-up assessment). Covariates included demographics, established environmental risk and protective factors for youth suicidality, psychopathology, and experiences or perpetration of offline peer aggression. Results: A total of 10 414 ABCD participants were included in this study. Participants had a mean (SD) age of 12.0 (0.7) years and 4962 (47.6%) were female; 796 (7.6%) endorsed suicidality. A total of 930 (8.9%) reported experiencing cyberbullying and 96 (0.9%) reported perpetrating cyberbullying. Of the perpetrators, 66 (69.0%) also endorsed experiencing cyberbullying. Controlling for demographics, experiencing cyberbullying was associated with suicidality (odds ratio [OR], 4.2 [95% CI, 3.5-5.1]; P < .001), whereas perpetrating cyberbullying was not (OR, 1.3 [95% CI, 0.8-2.3]; P = .30). Experiencing cyberbullying remained associated with suicidality when accounting for negative life events, family conflict, parental monitoring, school environment, and racial and ethnic discrimination (OR, 2.5 [95% CI, 2.0-3.0]; P < .001) and when further covarying for internalizing and externalizing psychopathology (OR, 1.8 [95% CI, 1.4-2.4]; P < .001). Both being a target and being a perpetrator of offline peer aggression were associated with suicidality (OR, 1.5 [95% CI, 1.1-2.0] for both), controlling for all covariates described earlier. Cyberbullying experiences remained associated with suicidality (OR, 1.7 [95% CI, 1.3-2.2]; P < .001, controlling for all covariates) when included with offline peer aggression experiences and perpetration. Conclusions and Relevance: In this cross-sectional study, experiencing—but not perpetrating—cyberbullying was associated with suicidality in early adolescence. This association was significant over and above other suicidality risk factors, including offline peer aggression experiences or perpetration. These findings can inform adolescent suicide prevention strategies, and they suggest that clinicians and educational staff working with this population should routinely evaluate for adolescents’ experience with cyberbullying.
Kirmayer, L.J. (2022). Suicide in cultural context: An ecosocial approach. Transcultural Psychiatry, 59(1), 3-12. DOI: 10.1177/13634615221076424
A Canadian study of suicide in a cultural context. Developmental and social factors, such as exposure to violence, childhood abuse and privation are examined.
Abstract – This article introduces a thematic issue of Transcultural Psychiatry on suicide in cultural context. Developmental and social structural factors including exposure to violence, childhood abuse and privation, as well as intractable social problems that create psychic pain and a sense of entrapment have been shown to increase the risk of suicidal behavior. However, all of the major social determinants identified in suicide research are influenced or mediated by particular cultural meanings and contexts. To move beyond crude generalizations about suicide based on psychological theories developed mainly in Western contexts and culture-specific prototypes or exemplars, we need more fine-grained analysis of the experience of diverse populations. The articles in this issue provide clear illustrations of the impact of cultural and contextual factors in the causes of suicide, with implications for psychiatric research, theory, and practice. Cross-cultural research points to the possibility of developing a typology of social predicaments affecting specific sociodemographic groups and populations. This typology could be elaborated and applied in clinical and public health practice through an ecosocial approach that considers the ways that suicide is embodied and enacted in social systemic contexts.
Rogers, M., Gai, A. & Musacchio, K. (2022). Why does safety planning prevent suicidal behavior? Professional Psychology: Research and Practice, 53(1), 33-41. DOI: 10.1037/pro0000427
An analysis of the steps involved in safety planning intervention is undertaken. The authors also review the literature demonstrating its efficacy.
Abstract – Safety planning interventions have demonstrated efficacy in reducing suicidal ideation, suicide attempts, and death by suicide. Less is known, however, about potential mechanisms underlying the effectiveness of safety plans. The present manuscript provides an overview of the steps involved in safety planning, reviews literature demonstrating its efficacy, and proposes seven potential factors that may explain why safety planning works: providing distraction, increasing connection, promoting autonomy, building competence, reducing engagement in impulsive urges, hindering engagement in suicidal behavior, and reducing cognitive load. By improving our understanding of why safety planning is effective, future work may be able to enhance, or augment, safety planning to further increase its efficacy and, ultimately, to save lives.
Depa, N., Desai, S., Patel, S., Silvi S., Hanif, S., Rizvi, S., Rahman, F., Ortega, G., Hsieh, Y., Malik, P., Pathrose, R., Parikh, T. & Mansuri, I. (2022). Mental health disparities amongst sexual-minority adolescents of the US: A national survey study of YRBSS-CDC. Psychiatry Research. DOI: 10.1016/j.psychres.2022.114635
Data from the Youth Risk Behavior Surveillance System (YBSS) from 2015 to 2019 were used to determine the prevalence of substance abuse, hopelessness, and suicidality among sexual minority adolescents in the United States. A comparison with their heterosexual peers was made.
Abstract – Objective: We aimed to evaluate the prevalence and trend of identifying as a sexual minority among the American adolescent population. Additionally, we aimed to evaluate the prevalence and odds of substance abuse, hopelessness, and suicidality among the sexual minority adolescents compared to their heterosexual peers. Methods: We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) data from 2015 to 2019. YRBSS divides “Sexual identity” into three groups: heterosexuals, sexual minorities (gay or lesbian or bisexual), and unsure. We identified “hopelessness and suicidality” using the survey questions exploring if participants felt sad or hopeless for >2 weeks, considered suicide, made a suicide plan, and attempted suicide requiring medical care. Univariate and multivariable survey logistic regression analyses were performed to establish an association between hopelessness, suicidality, substance abuse, and identifying as a sexual minority.
Results: Out of 41,377 adolescents, 4055 (9.8%) identified as a sexual minority. An increasing percentage of adolescents identified themselves as a sexual minority between 2015 to 2019 (8% to 11.2%) (pTrend<0.0001). The sexual minority had a higher prevalence of feeling sad and hopeless (63.4 vs. 28.6%), considering suicide (46 vs. 14.2%), planning suicide (38.9 vs. 11.5%), attempting suicide, and having injurious suicide attempts compared to heterosexuals. (p<0.0001) Amongst sexual minorities, the prevalence of substance abuse was higher compared to their heterosexual peers, which includes cigarettes (15 vs 7.8%), e-cigarette (27.2 vs 23.2%), inhalants (14.1 vs 5.3%), cocaine (8.4 vs 3.9%), marijuana (31.2 vs 20.2%), alcohol (36.9 vs 30.3%), steroids (6.4 vs 2.2%), heroin (4.4 vs 1.2%), and injectable drugs (4.0 vs 1.1%) (p<0.0001). In regression analysis, the sexual minority had higher odds of substance abuse, feeling sad and hopeless (aOR:4.6; 95%CI:4.0-5.2; p<0.0001), considering suicide (3.2; 2.8-3.7; p<0.0001), planning suicide (2.0; 1.7-2.3; p<0.0001) compared to heterosexual. Conclusion: Sexual minorities not only have higher prevalence and odds of hopelessness and suicidality but also have higher prevalence and odds of substance abuse like cigarettes, marijuana, cocaine, heroin, inhalants, and steroids. Hence, early identification, risk stratification, and interventions to reduce mental health disparities are needed.
Olsen K., Terry, J. & Thompson, W. (2022). Psychosocial risks and benefits of exposure to heavy metal music with aggressive themes: Current theory and evidence. Current Psychology. DOI: 10.1007/s12144-022-03108-9
This review looks at exposure to heavy metal music and the prevalence of aggressive behaviours, as well as substance use, anxiety, depression, and suicidal ideation.
Abstract – Concerns have been raised that prolonged exposure to heavy metal music with aggressive themes can increase the risk of aggression, anger, antisocial behaviour, substance use, suicidal ideation, anxiety and depression in community and psychiatric populations. Although research often relies on correlational evidence for which causal inferences are not possible, it is often claimed that music with aggressive themes can cause psychological and behavioural problems. This narrative review of theory and evidence suggests the issues are more complicated, and that fans typically derive a range of emotional and social benefits from listening to heavy metal music, including improved mood, identity formation, and peer affiliation. In contrast, non-fans of heavy metal music — who are often used as participants in experimental research on this topic — invariably report negative psychological experiences. Our review considers a comprehensive set of empirical findings that inform clinical strategies designed to identify fans for whom heavy metal music may confer psychological and behavioural risks, and those for whom this music may confer psychosocial benefits.
Cellarus, K., Tuttle, A. & Sevey, L. (2022). Tools for addressing intimate partner violence and suicide risk: Lessons learned from OHA’s Emergency Response for Suicide Prevention Grant. Portland, OR: Portland State University.
This document is the result of a collaboration of the Oregon Coalition Against Domestic and Sexual Violence (OCADSV), the Oregon Health Authority (OHA), and Portland State University’s Regional Research Institute for Human Services (PSU RRI). The aim of the collaboration was to enhance support for domestic violence and mental health agencies during COVID-19.
Abstract – In August 2020, the Oregon Coalition Against Domestic and Sexual Violence (OCADSV), the Oregon Health Authority (OHA), and Portland State University’s Regional Research Institute for Human Services (PSU RRI) began an 18-month collaboration to strengthen support for domestic violence and mental health agencies during COVID-19. As part of this grant, six domestic violence advocacy organizations around Oregon were able to place co-located advocates with their mental health partner agencies for services and cross-training. The content of this booklet is another product of this collaboration.
Krisnan, N., Steene, L., Lewis, M., Marshall, D. & Ireland, J. (2022). A systematic review of risk factors implicated in the suicide of police officers. Journal of Police and Criminal Psychology. DOI: 10.1007/s11896-022-09539-1
This is a systematic review of 20 studies looking at law enforcement suicide.
Abstract – Suicide has long been considered as nearing ‘epidemic levels’ in law enforcement populations. Nevertheless, despite the argued scale of the problem, no review has yet systematically examined the evidence base to elucidate the risk factors or predictors implicated in the suicidal behaviours of police officers. The current review aims to do this, by considering a final sample of 20 papers that met inclusion criteria. Findings from this qualitative review revealed five superordinate risk factors (i.e., Problematic substance use close to, or at the time of death; Presence of depression and previous suicide attempts; Differences in trauma response; Exposure to excessive and prolonged job-related stress, including dissatisfaction; Absence of a stable intimate relationship), which when taken in isolation each incrementally contributed to suicide risk, but when found to be comorbid, appeared to markedly increase the likelihood of completed suicide. Implications for suicide prevention, policy design, and treatment formulation are discussed, along with limitations and directions for future research.
Flannigan, K., Wrath, A., Badry, D., McMorris, C., Ewasiuk, A., Campbell, A. & Harding, K. (2022). Fetal Alcohol Spectrum Disorder and suicidality: What does the literature tell us? Journal of Mental Health Research in Intellectual Disabilities, 15(3).
A review of 28 articles from both the academic and grey literature was conducted looking at the relationship between Fetal Alcohol Spectrum Disorder and suicidal behaviours.
Abstract – Limited research has been conducted on suicidality among individuals with FASD. The purpose of this scoping review was to understand (1) how suicidality has been measured; (2) what proportion of individuals experience suicidality across the lifespan; and (3) what contextual factors are associated with suicidality. Method: We conducted a scoping review of the literature on FASD and suicidality. Twenty-eight articles and gray literature sources were included. Results: We identified an elevated risk of suicidal ideation, attempts, and death among individuals with FASD. Most studies were Canadian, published within the last 10 years, and focused on adolescents and adults in clinical settings. Only six studies were specifically designed to examine suicidality in FASD. Conclusion: This review provides a foundational understanding of suicidality in FASD with important implications for research, policy, and practice. Rates of suicidality across the lifespan are high, underscoring the need for evidence-based approaches to screening, prevention, and treatment.
Haugen, J., Sutter, C., Tinstman Jones, J. & Campbell, L. (2022). Teachers as youth suicide prevention gatekeepers: Examination of suicide prevention training and exposure to students at risk of suicide. Child & Youth Care Forum. DOI: 10.1007/s10566-022-09699-5
This is a study looking at teachers who receive youth suicide prevention training. Their attitudes toward suicide and feelings of self-efficacy in suicide prevention are measured.
Abstract – Background: Teachers are important gatekeepers in suicide prevention for children and youth, yet little is known about factors that contribute to suicide prevention training effectiveness and the influence of student suicidality on teachers’ role as gatekeepers. Objective – This study examined teachers’ attitudes and self-efficacy in suicide prevention including an examination of suicide prevention training and exposure to student suicidality. Researchers examined incremental prediction of the relationship between teachers’ self-efficacy, outcome expectations, and outcome values following prevention training. Methods – Participants included teachers in PreK-12th grade schools in the United States (N = 505). Researchers used non-parametric statistics to examine group level differences and a structural equation model (SEM) to test the proposed theoretical model. Results – Teachers who experienced a student death by suicide reported significantly higher levels of gatekeeper reluctance than teachers who had not experienced a student death by suicide (p < 0.01). Similarly, teachers who encountered students with suicidal thoughts reported greater levels of gatekeeper reluctance (p < 0.01) and higher self-efficacy to engage in suicide prevention (p < 0.05) compared to teachers who had not had this exposure. Results of the SEM indicated an adequate goodness of fit and fit statistics [χ2 (87) = 194.420, p = 0.000; CFI = 0.95; RMSEA = 0.05]. The model remained in-tact when exposure to student suicide was added. Conclusions – Findings support the importance of supporting teachers continued engagement in youth suicide prevention and prevention training that targets specific outcomes in teachers’ attitudes and efficacy.
Barker, J., Oakes-Rogers, S. & Leddy, A. (2022). What distinguishes high and low-lethality suicide attempts in older adults? A systematic review and meta-analysis. Journal of Psychiatric Research. DOI: 10.1016/j.jpsychires.2022.07.048
This is a systematic review of studies distinguishing between older adults who attempt suicide using means of low lethality and those who choose means of high lethality.
Abstract – Those making suicide attempts with highly lethal medical consequences are arguably the best proxy for those who die by suicide and represent a qualitatively different population from those making lower lethality attempts. Different factors influence the likelihood of a suicide attempt occurring and the lethality of that attempt. Both are important dimensions of risk. Older adults represent a distinct group in suicide research with unique risk factors that influence the lethality of their suicide attempts. This systematic review and meta-analysis summarises factors distinguishing those making high and low-lethality suicide attempts in older adulthood. Databases PsycINFO, PubMed (MEDLINE), Embase and CINAHL were systematically searched with seven of 1182 unique records included. Random effects meta-analyses were conducted on 18 variables in addition to a narrative synthesis regarding executive function. Only increased suicidal intent and planning meaningfully distinguished high from low-lethality attempters in meta-analyses. A large effect size was additionally observed for white ethnicity. Diminished alcohol use disorder prevalence and depression severity, and greater cognitive impairment, may be associated with high lethality attempters but further research is needed. Age and gender were not associated with lethality, contrary to adult populations. A narrative synthesis of studies exploring differences in executive functioning suggested high-lethality attempters were less likely to impulsively act on suicidal urges, allowing them to better plan suicide attempts that are more lethal, and are less likely to alter suicidal plans. Key limitations were that meta-analyses were underpowered to detect small effect sizes, and samples were largely white and limited to the USA.