Research Roundup – December 2022
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month:
🇨🇦 Cote, L. & Mishara, B. (2022). Effect of helping suicidal people using text messaging: An evaluation of effects and best practices of the Canadian suicide prevention service’s text helpline. Suicide and Life-Threatening Behavior. https://doi.org/10.1111/sltb.12908
This paper examines text messaging, a newer and under-researched modality of suicide crisis lines.
Abstract – Objective: To describe the users of the CSPS text service, explore the perceived impact of the service, and identify intervention characteristics associated with a greater likelihood of positive or negative effects of the exchanges. Method: We analyzed data from 112 transcripts using quantitative content analysis, counselor assessments of the calls, and responses by callers to pre-call questionnaires. Results: Counselors infrequently conducted a complete suicide risk assessment, but almost always thoroughly explored resources and discussed possible solutions to callers’ problems. An operational action plan was rarely developed. Only one technique, reinforcing a strength or a positive action of the caller, was a significant predictor of positive effects of the call. The number of words exchanged during the intervention was positively correlated with the completeness of explorations of resources and solutions and the development of an action plan. Conclusion: High-quality effective interventions can be delivered via text messages. Using reinforcement of strengths and encouraging longer calls is recommended. Intervention effects were comparable to those reported in studies of telephone and chat services.
Favril, L., Shaw, J. & Fazel, S. (2022). Prevalence and risk factors for suicide attempts in prison. Clinical Psychology Review, 97. https://doi.org/10.1016/j.cpr.2022.102190
This is a systematic review of the prevalence of attempted suicide during prison incarceration. 20 studies comprising 19,882 individuals were examined.
Abstract –Suicidal behaviour represents a substantial burden of morbidity and mortality in prisons worldwide. We aimed to synthesize the evidence on prevalence and risk factors for suicide attempts during incarceration. In this systematic review and meta-analysis, we searched four bibliographic databases for studies (published up to May 31, 2022) reporting on adults sampled from the general prison population who attempted suicide while incarcerated and an unselected comparison group. A total of 20 studies comprising 19,882 individuals (6.5% women) in 20 countries were eligible for inclusion. The pooled prevalence of suicide attempts during incarceration was 8.6% (95% CI 6.1–11.2) in men and 12.2% (95% CI 7.1–17.2) in women. Across all 36 risk factors studied, the strongest associations were found for suicidal ideation, previous self-harm, and markers of psychiatric morbidity. Prison-related risk factors included solitary confinement, victimization, and poor social support while incarcerated. Sensitivity analyses indicate that risk factors for near-lethal suicide attempts are similar to those for suicide attempts more generally. In addition to providing a synthesis of previous work, our systematic review highlights several key limitations of the extant literature, which provide directions for future research.
Gilgoff, J. N. et al. (2022). Help-seeking and man therapy: The impact of an online suicide intervention. Suicide and Life-Threatening Behavior. https://doi.org/10.1111/sltb.12929
Man Therapy (MT) is an online suicide intervention which aims to facilitate male mental health help-seeking. This study of men 25-64 in Michigan looked at MT and its effect on help seeking behaviours.
Abstract – Introduction: Suicide is a leading cause of death for men in the United States. Men traditionally have been hesitant to seek help, based on masculine norms of stoicism and self-reliance, among other factors. Man Therapy (MT) is an online suicide prevention and mental health initiative that provides promise for facilitating male help-seeking. Methods: This study draws on data from a randomized controlled trial which examined effects of MT on a sample of men residing in Michigan aged 25–64. The current study utilized logistic regression to test MT’s effect on nonprofessional and professional help-seeking, controlling for marital status, education, and sexual orientation. Results: A statistically significant positive association was found between MT and professional help-seeking (OR = 1.55, p = 0.049). A significant inverse association was also found with marital status, with partnered men less likely to seek professional help (OR = 0.53, p = 0.007). There was no significant association between MT and nonprofessional help-seeking. Conclusion: Man Therapy demonstrates the promise of web-based suicide prevention efforts to reach men who typically do not engage in help-seeking, providing a gateway to vital professional support. As technology continues to emerge, further suicide research is needed on use of this modality with working-age men from diverse backgrounds.
Goodwin, G. M. et al. (2022). Single-dose psilocybin for a treatment-resistant episode of major depression. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2206443
This is a study looking at the efficacy of psilocybin treatment for those experiencing major depressive disorder and are considered “treatment resistant”. Clinical trials were conducted in 10 countries at 22 sites from 2019 to 2021.
Abstract – Background: Psilocybin is being studied for use in treatment-resistant depression. Methods: In this phase 2 double-blind trial, we randomly assigned adults with treatment-resistant depression to receive a single dose of a proprietary, synthetic formulation of psilocybin at a dose of 25 mg, 10 mg, or 1 mg (control), along with psychological support. The primary end point was the change from baseline to week 3 in the total score on the Montgomery–Åsberg Depression Rating Scale (MADRS; range, 0 to 60, with higher scores indicating more severe depression). Secondary end points included response at week 3 (≥50% decrease from baseline in the MADRS total score), remission at week 3 (MADRS total score ≤10), and sustained response at 12 weeks (meeting response criteria at week 3 and all subsequent visits). Results: A total of 79 participants were in the 25-mg group, 75 in the 10-mg group, and 79 in the 1-mg group. The mean MADRS total score at baseline was 32 or 33 in each group. Least-squares mean changes from baseline to week 3 in the score were −12.0 for 25 mg, −7.9 for 10 mg, and −5.4 for 1 mg; the difference between the 25-mg group and 1-mg group was −6.6 (95% confidence interval [CI], −10.2 to −2.9; P<0.001) and between the 10-mg group and 1-mg group was −2.5 (95% CI, −6.2 to 1.2; P=0.18). In the 25-mg group, the incidences of response and remission at 3 weeks, but not sustained response at 12 weeks, were generally supportive of the primary results. Adverse events occurred in 179 of 233 participants (77%) and included headache, nausea, and dizziness. Suicidal ideation or behavior or self-injury occurred in all dose groups. Conclusion: In this phase 2 trial involving participants with treatment-resistant depression, psilocybin at a single dose of 25 mg, but not 10 mg, reduced depression scores significantly more than a 1-mg dose over a period of 3 weeks but was associated with adverse effects. Larger and longer trials, including comparison with existing treatments, are required to determine the efficacy and safety of psilocybin for this disorder.
🇨🇦 Marbaniang, I. et al. (2022). Mental health services use and depressive symptom scores among gay and bisexual men in Canada. Social Psychiatry and Psychiatric Epidemiology. 57, 2333–2342. https://doi.org/10.1007/s00127-022-02362-3
This study uses data from the 2016 Canadian Community Health Survey (CCHC) to compare the utilization of mental health services for depressive symptoms of gay and bisexual men (GBM) with those of heterosexual men.
Abstract – Purpose: The purpose of this study is to evaluate the association between mental health services (MHS) use and depressive symptom scores among gay and bisexual men (GBM) and compare with heterosexual men in Canada. Methods: We used data from the 2015–2016 cycles of the Canadian Community Health Survey. Depressive symptoms were assessed using the PHQ-9 questionnaire (prior two weeks). MHS consultations with any licensed mental health professional (prior year) were categorized as 0, 1, 2–11, ≥ 12. We fit linear regression models to quantify the associations between MHS use and PHQ-9 scores, with an interaction term for sexual identity (GBM and heterosexual men). Models were adjusted for socioeconomic and health-related indicators. Results: Among 21,383 men, 97.3% self-identified as heterosexual and 2.7% as GBM. Compared to heterosexual men, GBM used any MHS (21% vs. 10%, p < 0.05) and consulted ≥ 2 health professionals for their mental health (6% vs. 2%, p < 0.05) in the preceding year more frequently. Overall, mean PHQ-9 scores were higher among GBM compared to heterosexual men (3.9 vs. 2.3, p < 0.05). Relative to no consultations, higher MHS use (2–11, ≥ 12 consultations) was associated with higher PHQ-9 scores (1.4–4.9 points higher). Associations between MHS use and PHQ-9 scores did not differ statistically between GBM and heterosexual men. Conclusion: Our findings were inconclusive in demonstrating a difference between heterosexual men and GBM for the association between MHS use and PHQ-9 scores. However, GBM consistently had higher average PHQ-9 scores for every category of consultations. Considering the higher use of MHS and higher burden of depressive symptoms among GBM, more research is needed.
🇨🇦 Marshall, C. A. et al. (2022). Effectiveness of suicide safety planning interventions: A systematic review informing occupational therapy. Canadian Journal of Occupational Therapy. https://doi.org/10.1177/00084174221132097
A systematic review of 22 studies gauging the effectiveness of suicide safety planning initiatives. 11 studies were of standard suicide safety plan interventions. 5 studies concerned electronically delivered SSP interventions. 5 studies looked at SSP interventions integrated with other approaches.
Abstract – Background: Suicide safety planning (SSP) is a suicide prevention approach that involves developing a collaborative plan between a service provider such as an occupational therapist and a person who is at risk of suicide. Purpose: To synthesize effectiveness studies on SSP. Method: Using the Joanna Briggs Institute methodology, we conducted a systematic review of effectiveness studies including a: (1) title and abstract screening; (2) full-text review; (3) critical appraisal; and (4) narrative synthesis. Findings: We included 22 studies. Critical appraisal scores ranged from 38.5 to 92.3 (m =63.7). The types of interventions included were: standard and enhanced SSP (n =11); electronically delivered SSP (n=5); and SSP integrated with other approaches (n=6). Only three studies identified meaningful activity as a component of SSP. Evidence across a range of studies indicates that SSP is effective for reducing suicide behaviour (SB) and ideation (SI). While some studies have demonstrated effectiveness for reducing symptoms of mental illness, promoting resilience and service use, the number of studies exploring these outcomes is currently limited. Implications: Occupational therapists support individuals expressing SI, and SSP is a necessary skill for practice.
🇨🇦 McVittie, J. & Ansloos, J. (2022). Supporting Indigenous child suicide prevention within classrooms in Canada: Implications for school psychologists and educators. Canadian Journal of School Psychology. https://doi.org/10.1177/08295735221136185
The researchers conducted interviews with school educators who work with Indigenous children. They sought to gauge what types of supports are needed within schools to address Indigenous child suicide and how school psychologists can enhance prevention efforts.
Abstract –Indigenous young people in Canada are disproportionately overrepresented in suicide rates and alarmingly, young children are accounted for in these disparities. Since children spend much of their day at school, schools are a vital context for suicide prevention, identification, and intervention. However, research indicates that educators often report that they feel unprepared to address mental health challenges within the classroom. Indigenous communities are developing community driven responses to suicide that are culturally relevant and strengths based. It is critical that these models are considered when developing such suicide prevention within schools as they diverge from medicalized focused approaches and attend to broader social dimensions. It is imperative that educators and the education system are properly equipped with the training and resources to provide suicide prevention within schools and communities servicing Indigenous children. School psychologists can play an important role in providing this prevention leadership. Through interviews with educators, we learned about the types of supports that are needed within schools to address Indigenous child suicide, and in what ways school psychologists could enhance prevention efforts. Using a reflexive approach to thematic analysis, we identified four main themes related to support needed. Findings are discussed in conversation with the current state of child specific suicide and suicide prevention literature. Applied implications for suicide prevention within schools for Indigenous children, as well as future research and community-based recommendations are considered.
Ponder, W. N. et al. (2023). Network analysis of distress, suicidality, and resilience in a treatment seeking sample of first responders. Journal of Affective Disorders, 320, 742-750. https://doi.org/10.1016/j.jad.2022.09.097
This study examines first responders seeking counselling who were surveyed between 2016 and 2021 to analyze the relationship between distress and suicidal behaviours and resiliency.
Abstract – Introduction: First responders are routinely and regularly exposed to traumatic events that can clinically manifest with a symptom constellation of post-traumatic stress disorder (PTSD), generalized anxiety, depression, and suicidality. Methods: We used network analysis to examine baseline data from treatment seeking first responders (n = 308) to examine the interrelatedness of those constructs, including a measure of resilience. We estimated two models: a regularized partial correlation network and a Bayesian Directed Acyclic Graph (DAG). Results: The models reveal converging evidence highlighting the central role of negative alterations in cognitions and mood PTSD cluster along with affective depression. These nodes did not significantly differ, though they were among the strongest in the partial correlation network and shared the most variance with the other nodes. The DAG results suggested that the negative alterations in cognitions and mood PTSD cluster predicted downstream constructs of affective depression; intrusion, hyperarousal, and avoidance PTSD clusters; and resilience. Only resilience and affective depression exhibited direct effects on suicidality. Both somatic depression and suicidality were endogenous endpoints in the DAG. Resilience exhibited an inverse path to suicide. However, resilience was relatively independent of the other constructs in the models and the DAG suggested that it was a consequence of PTSD related distress.
🇨🇦 Sinyor, M. et al. (2022). Suicide risk and prevention during the COVID-19 pandemic: One year on. Archives of Suicide Research. https://doi.org/10.1080/13811118.2021.1955784
This is an examination of the effects of the COVID-19 pandemic on suicidal behaviours and suicide prevention efforts so far. The authors suggest suicide prevention efforts going forward in the later stages of the pandemic and its aftermath.
Abstract – Emerging data from high and upper-middle-income countries indicate that suicide rates generally did not increase during the initial months of the COVID-19 pandemic, yet the pandemic’s impact on suicide is complex. We discuss the nuances of this relationship, how it may evolve over time, and describe the specific steps that governments and societies must take.
🇨🇦 Soullane, S. et al. (2022). Relationship between suicide attempt and medical morbidity in adolescent girls. Journal of Psychiatric Research,155, 42-48. https://doi.org/10.1016/j.jpsychires.2022.08.002
This study sought to examine attempted suicide during adolescence and subsequent adult medical morbidity. Hospital admission data of adolescent girls in Quebec between 1989 and 2019 were used.
Abstract – This study assessed whether suicide attempts before 20 years of age were associated with medical morbidity later in life. We carried out a cohort study of 169,806 girls under age 20 years between 1989 and 2019 in Quebec, Canada. The cohort included 8086 girls admitted for suicide attempts, matched on age and year with 161,720 girls with no attempt. Outcomes included hospitalization for medical conditions, such as infection, allergic disorders, autoimmune disease, cardiovascular disease, cancer, and death from nonpsychiatric causes during 31 years of follow-up. We computed hazard ratios (HR) and 95% confidence intervals (CI) for the association of adolescent suicide attempt with these health outcomes using Cox regression models adjusted for preexisting mental illness, substance use disorders, and socioeconomic deprivation. Compared with matched controls, adolescent girls with suicide attempts had a greater risk of hospitalization for infection (HR 1.55, 95% CI 1.44–1.68), allergic disorders (HR 1.72, 95% CI 1.45–2.05), cardiovascular disease (HR 1.31, 95% CI 1.12–1.52), and mortality (HR 3.11, 95% CI 1.69–5.70). Associations were present regardless of the age at the time of the suicide attempt but were stronger for girls with repeated attempts. Associations were also more pronounced within the first 5 years of the attempt, although suicide attempts remained strongly associated with mortality throughout the 31-year follow-up period. The findings suggest that adolescent girls with suicide attempts have an elevated risk of medical morbidity and mortality and may benefit from closer clinical management to prevent adverse health outcomes.
🇨🇦 Taylor, P. (2022). Challenging the myth of” attention-seeking” women with suicidality: A grounded theory study about applying counter-pressure to manage system entrapment. Issues in Mental Health Nursing. https://doi.org/10.1080/01612840.2021.2014608
This Canadian study examines women’s help-seeking behaviours and challenges the notion of these behaviours as “attention-seeking”. 32 women in New Brunswick with histories of intimate partner violence were interviewed.
Abstract – Some women who express suicidal intent and engage in non-lethal self-harm perceive that nurses and other health care workers label them as attention-seeking and manipulative. An understanding of women’s help-seeking behaviors that challenges suicide myths is presented. The purpose of this study was to examine help-seeking for suicidality in women with histories of intimate partner violence using a multiple qualitative research design of grounded theory and photovoice. Women from New Brunswick, Canada, over the age of 19 who left an abusive partner (n = 32) were interviewed and seven local women from this sample participated in five photovoice group sessions where they collectively examined self-generated photos of their experiences. Transcripts of the interviews and group sessions were analyzed using the constant comparative approach, yielding a theoretical rendering of women’s help seeking. Results include a process of Applying Counter-Pressure as a way of pushing back against System Entrapment, or the sense of being invalidated and dehumanized by health care providers with the goal to Feel Human. Findings provide an understanding of women’s behavior when seeking help for suicidality and may reduce nurses’ assumptions and judgments when providing care. Trauma and violence informed care provides a framework from which to guide interventions that acknowledge the role of past and ongoing trauma in women’s lives, supporting nurses’ capacity to be validating and helping women to continue living.
🇨🇦 Yang, F-J. et al. (2022). Examining variations in immigrants’ lower risk of suicide-related behaviours. Ottawa, ON: Statistics Canada. (2022). 23 p. https://www150.statcan.gc.ca/n1/daily-quotidien/221201/dq221201a-eng.htm
A Statistics Canada publication. The authors use data from the Canadian Community Health Survey (CCHS) for the years 2015, 2016, and 2019. They are principally interested in the prevalence of suicidal ideation and rates of suicide among immigrants and Canadian-born people.
Abstract – Suicide is a major cause of premature and preventable death in Canada, with about 4,000 individuals dying by suicide each year, and 1 in every 10 people having thoughts of suicide over their lifetimes. A new study released today titled “Examining variations in immigrants’ lower risk of suicide-related behaviours” confirmed that the prevalence of suicide and suicidal ideation was lower among the immigrant population compared with people born in Canada. Yet, among the immigrant population, the risk of suicide-related behaviours varied considerably by such factors as age, sex, having a mental health disorder, time since arrival in Canada and region of birth.