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

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Booth, M. et al. (2023). Re-thinking spatial design in homes to include means and access restrictions with material impacts as passive suicide prevention methods: A systematic review of design for Australian homes. Buildings.

This is a systematic review of suicide prevention measures in building design, especially in terms of means and access restriction and safety.

Abstract – This systematic review analyses research that introduces commercial design applications that could be adopted for suicide prevention in homes. Furthermore, this literature review captures social, spatial and biophilic design methods to improve wellness in homes using environmental design psychology. Safety and human wellness frame this spatial design research that examines means and access restriction to improve home safety and prevent suicides. Suicide is a growing phenomenon that deserves specific attention to how environments can impact or restrict events. There is a substantial evidence base to evaluate suicide prevention methods used in high-risk environments of health and healing environments, workplaces and incarceration facilities. This review outlines design methods using spatial arrangement and material choices to improve human wellness in homes. The effects of biochemical reactions, such as those studied in toxicology, and stress are considered in this research to suggest material choices and applications in design to improve mental health in homes. Spatial designs for suicide prevention can guide various prevention measures, such as adopting means and access restriction and environmental design methods for wellness and considering impacts during lockdown periods. Environmental design psychology research supplies evidence for improved spatial arrangements in homes, with evidence showing that design applications can restore and improve mental health. This systematic review shows evidence for planning methods to prevent suicides considering both means and access restriction with considerable biochemical impacts from design. Design methods discovered by this systematic review will be considered for future studies and used within economic modelling to demonstrate design guidelines that improve wellbeing and support existing suicide prevention methods for Australian homes.

Barber, C. et al. (2023). Selection and use of firearm and medication locking devices in a lethal means counseling intervention.  Crisis. 44(3), 216–223.

This is a study looking at the prevalence and choice of firearm and medication locking devices in the context of a lethal means counselling intervention.

Abstract – Background: While some suicide prevention initiatives distribute locking devices for firearms and medication, little evidence exists to guide the selection of devices. Aims: This study aimed to describe safety standards for locking devices and compare parental acceptance rates for different types of devices. Method: As part of the larger SAFETY Study, behavioral health clinicians provided free locking devices to parents whose child was evaluated in the emergency department (ED) for a suicide-related or behavioral health-related problem. For logistical reasons, we changed the specific devices offered midstudy. Data on device use came from follow-up interviews with 226 parents. Results: Few effective standards exist for locking devices for home use; we could easily break into some. At follow-up, twice as many gun-owning parents were using ED-provided handgun lockboxes as cable locks (28% vs. 14%, p = .02). Overall, 55% of parents reported using an ED-provided medication lockbox, with more using the drawer-sized lockbox than the larger, steel toolbox (60% vs. 42%, p < .01). Limitations: Storage outcomes are from parents’ self-report and from one state only. Conclusion: Parents appeared to prefer some devices over others. Our findings suggest the need for (a) effective safety standards, (b) affordable devices meeting these standards, and (c) further research on consumer preferences to ensure use.

🇨🇦Mitchell, R.H.B. et al. (2023). Sex differences in suicide trends among adolescents aged 10 to 14 years in Canada. The Canadian Journal of Psychiatry

Male and female adolescents aged 10 to 14 years are compared to measure their respective suicide rates by sex.

Abstract – Suicide rates appear to be rising rapidly among youth in North America. Historically, adolescent males have had much higher rates than females; however, this gap may be narrowing due to rising suicides among female adolescents. Over the last 40 years, reported youth suicide rates in the United States have increased most disproportionately among females aged 10 to 14 years, mainly by hanging and suffocation, but also by self-poisoning in the 10- to 12-year age group. In Canada, reported rates among females aged 10 to 14 have also steadily increased while rates among males have remained stable or declined.  Although Canadian studies have presented suicide rates in young women across age brackets, no study has tested for sex differences in the 10 to 14 age group specifically.

London-Nadeau, K. et al. (2023). Social support and mental health among transgender and nonbinary youth in Quebec. LGBT Health. 10(4), 306-314.

Data from the Canadian Trans Youth Health Survey are used to measure social support, physical health and mental health among 220 trans and non-binary youth.

Abstract – Purpose: Transgender and nonbinary (TNB) youth face elevated levels of discrimination, stigma, mental health disorders, and suicidality when compared with their cisgender counterparts. Family and school support may mitigate some of the effects of the stressors facing TNB youth. This study aimed to better understand the impact of each of these sources of support on TNB youths’ mental health and wellbeing. Methods: We used data collected between 2018 and 2019 as part of the Canadian Trans Youth Health Survey, a bilingual online survey to measure social support, physical health, and mental health in a sample of 220 TNB youth aged 14-25 living in Québec, Canada. We examined the relationships among different sources of support, and mental health and wellbeing outcomes using logistic regression. Analyses were conducted on the full sample and according to linguistic groups (French and English). Results: Participants reported high levels of mental health symptoms, self-harm, and suicidality, and mental health symptoms were higher in the English-speaking group (p = 0.005). In models controlling for age, family connectedness was associated with good/excellent self-reported mental health (odds ratio [OR] = 2.62, p = 0.001) and lower odds of having considered suicide (OR = 0.49, p = 0.003) or attempted suicide (OR = 0.43, p = 0.002), whereas school connectedness was associated with higher odds of good/very good/excellent general (OR = 2.42, p = 0.013) and good/excellent mental (OR = 2.45, p = 0.045) health. Conclusion: Family and school support present consistent associations with TNB youths’ health and may constitute key areas for intervention for those supporting them.

Chen, Q. et al. (2023). Neurocognitive and clinical characteristics of elementary school-aged children with a history of suicidal thoughts and behaviors. Journal of Affective Disorders, 339, 318-324.

There are reports that suicidal ideation and suicidal behaviours are on the increase among elementary school-age children, The neurocognitive and clinical behaviours of the children of 93 families were examined and used to compare children with a history of STBs and those without. 

Abstract – Background: Suicidal thoughts and behaviors (STBs) in elementary school-aged youth have increased in recent years. Understanding the risks associated with childhood STBs is necessary for prevention efforts. Methods: The current study examined clinical and neurocognitive characteristics of a community sample of elementary school-aged children with (STB+) and without (STB-) a history of STBs. The final sample included 93 families with children average age of 7.8 years (SD = 1.3). Children in this sample were racially diverse, evenly split by sex, and most identified as non-Hispanic. Neurocognitive functioning was assessed using computerized behavioral measures. Child clinical characteristics were assessed using self-report measures and STB history was assessed using semi-structured interviews. Results: Of the 93 families, 64 STB- children and 29 STB+ children participated. On average, STB+ children were older, reported higher levels of depressive and anxiety symptoms, and were more likely to have a parental history of suicidal behavior (PH+). Regarding neurocognitive functioning, STB+ children exhibited lower raw scores for both the NIH Dimensional Change Card Sort Task (NIH-DCCS) and NIH Flanker Inhibitory Control and Attention Test (NIH-Flanker). Multivariable regression analyses revealed raw scores for NIH-DCCS and NIH-Flanker, PH+ status, and child age were associated with childhood STBs. Limitations: Prospective data is needed to confirm cross-sectional findings. Conclusions: Poorer neurocognitive functioning and PH+ status may serve as risk markers for STBs in elementary school-aged children. Targeting prevention programming for these risks may reduce the likelihood of STBs in at-risk elementary school-aged youth.

🇨🇦 Stijelja, S. & Mishara, B. (2023). Characteristics of incel forum users: Social network analysis and chronological posting patterns. Studies in Conflict & Terrorism

This is a study of three popular involuntary celibate (incels) online forums. The characteristics of its users are analyzed. 

Abstract – Incels, Involuntary Celibates, are men who both struggle with lack of sexual and romantic relationships and participate in online communities espousing a misogynistic ideology. This study characterizes users of three popular Incel forums. Using network analysis and community detection, we identify their main issues and interests and assess whether interests predated or followed their initial participation in an Incel forum. Results indicate that users commonly engage with content concerning mental health and relationships, but also participate in other hateful forums. Contributions to hateful forums mostly predated their earliest engagement with an Incel forum. Implications for prevention and intervention are discussed.

Visser, V. & Tretheway, R. (2023). A longitudinal study of the impact of a suicide bereavement service on people bereaved by suicide. OMEGA—Journal of Death and Dying.

This is a study examining the long-term effects of StandBy, an Australian suicide bereavement service for people bereaved by suicide. 

Abstract – Whilst the body of research on the impacts of suicide bereavement interventions continues to grow, there is little understanding of the impact over time. This study measured changes in suicidality, levels of loneliness and grief reactions over time between those receiving support from a community-based suicide bereavement service (StandBy) compared with those that did not receive this support. Data were collected through an online survey with participation at baseline being varying times post loss, and three-months post-baseline (StandBy n = 174, Comparison n = 322). Statistical analysis included linear mixed-effects modelling for repeated measures. Results were consistent with earlier studies showing the positive impact of StandBy on participants’ grief responses, loneliness and suicidality, specifically within the first 12 months after their loss. However, these outcomes were not retained over time, with the exception of suicidality. Further longitudinal studies consisting of more than two time-points and a greater period between time-points is warranted.

Ezquerra, B. et al. (2023). Characteristics of single vs. multiple suicide attempters among adolescents: A systematic review and meta‑analysis. European Child & Adolescent Psychiatry.

This is a systematic review and meta-analysis of studies looking at the differences between adolescents and children who have attempted suicide a single time, compared with those who have attempted two or more times. 14 studies were included in the review and 13 studies were included in the meta-analysis. 

Abstract – There might be differential characteristics between those who have attempted suicide once in their lifetime (single attempters) and those who have attempted suicide two or more times (multiple attempters). We aimed to identify the factors that differentiate single and multiple attempters in child and adolescents. This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the review protocol was registered in PROSPERO. We conducted a systematic literature search in three databases to identify original studies exploring the characteristics of single attempters vs. multiple attempters among adolescents. We considered a wide range for the definition of adolescent, following most recent recommendations: 10-24 years. We carried out a meta-analysis. Fourteen studies were included in the systematic review and 13 in the meta-analysis with a total sample of with a total of 4286 participants. The factors statistically significantly associated with being a multiple attempter in the meta-analysis were: anxiety disorders, depression severity, alcohol abuse, substance abuse, aggressiveness, and hopelessness. Multiple attempters have a more severe clinical profile, with greater severity of symptoms. Knowledge of the risk factors associated with being a multiple attempter could help us to predict which patients are more likely to reattempt suicide and need further monitoring and a tailored treatment. Prevention programs tailored for the adolescent population, along with identification of early risk factors, could help to prevent suicidal behavior among this vulnerable population.

Kahn, G. et al. (2023). Recorded diagnosis of gender identity disorder is strongly associated with suicide mortality. Transgender Health.

Data culled from nine health care systems were used to determine whether there is an association between diagnosed gender identity disorder (GID) and increased suicide risk. 

Abstract – We assessed the association between gender identity disorder (GID) diagnosis and suicide in a retrospective case–control study (N=300,364) from nine health care systems between 2000 and 2015. Adjusting for age and sex, the odds ratio for GID was 18.6 (95% confidence interval 7.0–49.5). Adjusting additionally for comorbid psychiatric diagnoses, the odds ratio was 4.75 (1.78–12.68), higher than depressive (3.96, 3.64–4.31), alcohol use (3.42, 3.04–3.84), bipolar (2.42, 2.10–2.80), and psychotic disorders (1.44, 1.22–1.70). These U.S. data support prior research demonstrating increased suicide risk among patients with diagnosed GID, who may benefit from targeted screening and intervention within health care systems.

Rodrigues da Silva, C. et al. (2023). Suicide in veterinary medicine: A literature review. Veterinary World, 16(6), 1266-1276.

The authors review studies of veterinarians and suicide. They identify and advocate several actions that should be taken in the veterinary community. 

Abstract – Veterinarians are commonly exposed to occupational stressors, including excessive workload and financial constraints. These stressors can lead to psychological distress, which typically results in mental health disorders such as depression, anxiety, and burnout and can even culminate in suicide attempts or suicide deaths. Risk factors associated with poor mental health and high rates of suicide in veterinary practitioners include continuous exposure to challenging scenarios, such as interpersonal conflicts, performing euthanasia, and easy access to lethal means of suicide, such as opioids and anesthetics. The previous studies highlight the urgent need for a better understanding of predisposing factors, mental health-related improvements in the professional environment, and the subsequent establishment of primary mental health-related care policies. Effective ways to promote mental health and prevent suicide may include social support, resilience, developing coping skills, promoting a healthy work environment, and discouraging perfectionist behaviors. This review aimed to summarize findings in studies that have investigated mental health and suicide in veterinarians and veterinary students and highlight measures that could be implemented as options for mental health promotion and suicide prevention.

Goel, D. (2023). Is suicide a mental health, public health or societal problem? Current Opinion in Psychiatry.

An editorial criticizing the mainstream practice of viewing suicide as solely mental and public health problem without consideration for social, cultural, and historical factors. Over-reliance on psychological autopsies and risk assessments are also questioned. The authors call for alternative approaches which view suicide in a more holistic manner. 

Abstract – Suicide is a complex phenomenon wherein multiple parameters intersect: psychological, medical, moral, religious, social, economic and political. Over the decades, however, it has been increasingly and almost exclusively come to be viewed through a biomedical prism. Colonized thus by health and more specifically mental health professionals, alternative and complimentary approaches have been excluded from the discourse. The review questions many basic premises, which have been taken as given in this context, particularly the ‘90 percent statistic’ derived from methodologically flawed psychological autopsy studies. Recent findings:  An alternative perspective posits that suicide is a societal problem which has been expropriated by health professionals, with little to show for the efficacy of public health interventions such as national suicide prevention plans, which continue to be ritually rolled out despite a consistent record of repeated failures. This view is supported by macro-level data from studies across national borders. Summary: The current framing of suicide as a public health and mental health problem, amenable to biomedical interventions has stifled seminal discourse on the subject. We need to jettison this tunnel vision and move on to a more inclusive approach.

🇨🇦 Varin, M. et al. (2023). Increased alcohol use, heavy episodic drinking, and suicide ideation during the COVID-19 pandemic in Canada. Canadian Journal of Public Health.

The authors use data from the Survey on COVID-19 and Mental Health 2020 to gauge the effects of alcohol consumption during the second wave (September to December 2020) COVID-19 pandemic. 

Abstract – Objective: Alcohol use is a known risk factor for suicidality, yet this relationship has not been explored during the pandemic in Canada. As a growing body of evidence demonstrates the negative impact of COVID-19 on alcohol consumption and associated harms in Canada, there is a need to examine this more closely. Methods: Using the Survey on COVID-19 and Mental Health 2020, we compared the prevalence of suicide ideation among: (1) individuals who reported an increase in alcohol consumption vs those who reported a decrease/no change, and (2) individuals who reported past month heavy episodic drinking vs those who did not. We compared overall unadjusted odds ratios and across a number of sociodemographic and mental health variables. All estimates were weighted to ensure they were nationally representative. Results: The prevalence and likelihood of suicide ideation were significantly higher among people who reported increased alcohol consumption during the pandemic (4.9% vs 2.0%; OR = 2.6, 95% CI: 1.8, 3.7) and people who reported past month heavy episodic drinking (3.4% vs 2.1%; OR = 1.7, 95% CI: 1.2, 2.3). Males and middle-aged and older-aged individuals had the highest odds ratios for increased alcohol consumption and past month heavy episodic drinking with suicide ideation. Conclusion: In the Canadian general population during the COVID-19 pandemic, there were significant associations between suicide ideation and increased alcohol use as well as past month heavy episodic drinking across specific sociodemographic subgroups. Future research could explore these associations while adjusting for social determinants of health such as income security, employment, education, social support, stress, and mental health.

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