Research Roundup – December 2023
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month.
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Tsai, M. & Klonsky, E. (2023). Warning signs for suicide attempts in psychiatric inpatients: Patient and informant perspectives. General Hospital Psychiatry. https://doi.org/10.1016/j.genhosppsych.2023.11.005
Psychiatric inpatients as well as friends, family, or caretakers of patients were surveyed to gauge their responses to various warning signs for suicidal behaviours.
Abstract – Objective: Warning signs can help prevent suicide attempts and death. It is important to develop an evidence base for warning signs that considers both self-perspectives (i.e., those at risk for suicide) and informant-perspectives (i.e., those who observe individuals at risk for suicide). Methods: A questionnaire assessing a diverse set of 80 potential warning signs (“present in the minutes, hours, or days before the suicide attempts”) was developed based on literature searches, lived experience consultations, and the American Association of Suicidology (AAS) expert consensus list. This questionnaire was administered to two samples: psychiatric inpatients who had attempted suicide (n = 476), and informants identified as friends, family, or caretakers of patients (n = 120). Results: Hopelessness, anxiousness, and unbearable pain were each endorsed as warning signs by >80% of inpatients and informants. Warning signs were similar across patient and informant perspectives, and across sociodemographic and clinical characteristics. Some AAS warning signs were endorsed by few patients and informants (risky behaviors, alcohol or drug use, seeking revenge) and may warrant re-evaluation. Conclusions: Findings are consistent with models of suicide risk emphasizing pain, hopelessness, and anxiousness. Existing lists of warning signs may benefit from revision as the evidence base continues to develop.
Frazer, H. & Giles, A. (2023). Are sport and traditional Inuit games identified as tools in current Inuit suicide prevention strategies. A content analysis. International Journal of Circumpolar Health. https://doi.org/10.1080/22423982.2023.2276983
The authors posit the benefits of sport and Inuit traditional games for the “emotional, mental, physical, and spiritual benefits” of Inuit, particularly Inuit youth. They conducted a content analysis of several Inuit suicide prevention strategies to identify the absence or presence of these activities.
Abstract – Eekeeluak Avalak, an 18-year-old Inuk wrestler who won the first-ever gold medal for Nunavut at the Canada Summer Games in 2022, dedicated his win to his late brother who died by suicide in 2015. Avalak openly attributed sport – specifically wrestling – to saving his own life. This story raises important questions about the role of sport and traditional games in Inuit suicide prevention strategies. Few studies have examined the role of sport or traditional games in Inuit suicide prevention strategies. In an attempt to reduce Inuit suicide rates, in addition to the National Inuit Prevention Strategy, three of the four land claim regions that constitute Inuit Nunangat have suicide prevention strategies. In this study, we used settler colonial theory, critical Inuit studies, and content analysis to examine if and how sport and Inuit traditional games are identified as prevention tools in these Inuit suicide prevention strategies. The results demonstrate that sport and traditional games have largely been overlooked as protective factors in current Inuit-wide and land-claim specific suicide prevention strategies. Moving forward, evidence-based and community-driven approaches could be funded, created, implemented, and evaluated as culturally-safe Inuit mental health intervention models to address the disproportionately high suicide rates among Inuit in Inuit Nunangat.
Awaad, R. (2023). The development of a novel suicide postvention healing model for Muslim communities in the United States. Journal of Religion and Health. https://doi.org/10.1177/00207640211001084
The Stanford Muslim Mental Health and Islamic Psychology Lab at Stanford University has developed a model for suicide response and community healing for Muslim communities. The model is called The Muslim Postvention Community Healing Session and aims to create a model which will respond to suicide in culturally and religiously congruent ways that supports loss and promotes community healing.
Abstract – Suicide among American Muslims is understudied, despite recent research highlighting increased suicide attempts among this population. While suicide is forbidden in Islam, formal guidelines for addressing and responding to suicide within Muslim communities did not exist until recently. The Stanford Muslim Mental Health and Islamic Psychology Lab has responded to a number of suicides in Muslim communities across North America and implemented an original model for suicide response and community healing. This approach incorporates Islamic principles and values to create a culturally and religiously congruent response to suicide that can support loss survivors and steer impacted communities toward healing. The Muslim Postvention Community Healing session described in this paper aims to provide a safe space for individuals impacted by suicide to come together and process their emotions, while also using Islamic teachings to guide the healing process. This unique model has the potential to serve as a valuable resource for Muslim communities across North America, and beyond, in addressing and responding to suicide.
Thomas, B. (2023). “To show the problem inside and out”: Representations of mental illness and suicide in Eric Steel’s The Bridge. In Coleclough, S., Michael-Fox, B., Visser, R. (eds.). Difficult Death, Dying and the Dead in Media and Culture.
https://doi.org/10.1007/978-3-031-40732-1_2
This is a chapter from an anthology called Difficult Death, Dying and the Dead in Media and Culture. The chapter examines the 2006 documentary, The Bridge, which focuses “on the lives and deaths of six suicide victims who jumped from the Golden Gate Bridge in 2004”. The author questions whether the film creates awareness and education about suicide and suicide prevention or is a harmful conduit of suicidal contagion?
Abstract – The 2006 documentary The Bridge focuses on the lives and deaths of six suicide victims who jumped from the Golden Gate Bridge in 2004. Shot over a twelve-month period, the film presents the footage of each victim’s demise, recorded from the distant shoreline by director/producer Eric Steel and his crew. The Bridge has been criticized for publicizing these six individuals’ deaths and even blamed for the rise in bridge jumps following the film’s release. In contrast, Steel insists that his documentary serves to raise awareness of the need for more effective methods to identify and dissuade potential jumpers, as well as to rejuvenate efforts to secure the bridge with physical barriers. Is The Bridge a catalyst for change, or does it merely reduce suicide to spectacle? In addition to addressing such queries, this chapter analyzes Steel’s portrayal of the Golden Gate Bridge as a suicidal cluster site whose victims seem drawn to its beauty, simplicity, public profile, and high fatality rate. Also examined are the filmmakers’ efforts to humanize each suicide victim by reimagining the bridge as a contact zone between the individual’s struggle for peace and the broader social systems that might have failed this person.
Ricciardelli, R. et al. (2023). Provincial correctional workers: Examining the relationship between alcohol use, mental health disorders, and suicide behaviour. Canadian Psychology. https://doi.org/10.1037/cap0000374
This study looked at the prevalence of alcohol use among provincial correction workers and its relationship with mental health disorders and suicidal behaviours. Data were drawn from the Ontario Provincial Correctional Worker Mental Health and Well-Being Study conducted in 2017 and 2018.
Abstract – Alcohol use among correctional workers remains an understudied phenomenon, although recognized in literature as a coping strategy employed by persons in public safety occupations. Moreover, previous literature denotes a prevalence of mental health disorders higher than that of the general population among correctional workers and public safety personnel. In the present study, we examine the prevalence of alcohol use disorders among correctional workers employed in the provincial correctional service in Ontario, Canada (n = 915), to understand the severity of the concern and to explain how alcohol use is associated with diverse mental health concerns. Specifically, we unpack the correlation between problematic alcohol use, mental health disorders, and suicide behaviours among this correctional worker population, finding that the prevalence of mental health disorders and suicide thoughts and behaviours was higher for persons reporting problematic alcohol use. Discussion includes recommendations on research needs tied to unpacking the relationship, including causal relationship between alcohol use and mental health, as a way to combat the devastating realities tied to compromised mental health endured by employees in correctional services.
Shin, H.D. et al. (2023). Designing implementation strategies for a digital suicide safety planning intervention in a psychiatric emergency department: Protocol for a multimethod research project. JMIR Research Protocols.
https://doi.org/10.2196/50643
This is a study proposal which will analyze the Hope app, a smartphone app that provides suicide prevention information and tools, including a digital version of a safety plan. The study will be conducted in a psychiatric Emergency Departments in Toronto.
Abstract – Background: Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. Objective: The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians’ perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). Methods: We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. Results: This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. Conclusions: Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians’ behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature.
Shoib, S. et al. (2023). Prevention of suicides associated with global warming: Perspectives from early career psychiatrists. Frontiers in Psychiatry.
https://doi.org/10.3389/fpsyt.2023.1251630
Many psychiatrists anticipate major mental health impacts due to climate change. This paper addresses suicide as a result of climate change and how its prevention is best achieved.
Abstract – Climate change poses significant challenges to global mental health, with potential consequences including increased rates of suicide and mental health disorders. Early Career Psychiatrists (ECPs) play a crucial role in addressing these challenges. The Climate Psychiatry Alliance, a group of psychiatrists dedicated to improving mental health amidst climate change, recognizes the importance of cultivating climate-aware ECPs. Training ECPs to become confident climate-aware clinicians enables them to effectively treat patients experiencing anxiety, depression, and PTSD in the context of climate-related distress. Together with other mental health professionals, ECPs can contribute to efforts by implementing strategies for monitoring and treating mental health problems arising from climate events. Additionally, they can raise awareness about the psychological consequences and risks of suicide associated with climate change. Collaboration among ECPs from various regions is essential in developing community-based approaches and reducing vulnerabilities. ECPs must prioritize supporting vulnerable populations by advocating for increased funding for mental health support and research in affected areas. Long-term solutions to address the mental health impacts of climate change and global warming should be pursued to mitigate future suicidality. Integrating climate considerations into local mental health programs and expanding psychological support services is crucial. By promoting emotional resilience and self-awareness, ECPs can contribute to building a more climate-resilient and mentally healthy society.
Stanley, B. et al. (2023). Brief and ultra-brief suicide-specific interventions. Focus, 21(2), 129–136. https://doi.org/10.1176/appi.focus.20220083
The late Dr. Barbara Stanley is the co-author of the widely known safety plan intervention (SPI). In this paper, she and others review the SPI and several other brief and ultra-brief suicide interventions.
Abstract – The rising rates of suicide warrant effective treatments that can quickly help stabilize suicidal individuals and prevent future suicidal crises from occurring. Across the past few decades, there has been a rise in the development of ultra-brief (1–4 sessions) and brief suicide-specific interventions (6–12 sessions) to meet this need. This article reviews several prominent ultra-brief and brief interventions, including the Teachable Moment Brief Intervention, Attempted Suicide Short Intervention Program, Safety Planning Intervention, Crisis Response Planning, Cognitive Therapy for Suicide Prevention, Brief Cognitive-Behavioral Therapy for Suicide Prevention, Collaborative Assessment and Management of Suicidality, and the Coping Long-Term With Active Suicide Program. A brief review of each interventions’ evidence base is also provided. Current challenges and directions for future research in testing the efficacy and effectiveness of suicide prevention initiatives are discussed.
Glodstein, S.L. (2023). The lifeline and advanced practice nursing/intervention prevention perspective. Archives of Psychiatric Nursing.
https://doi.org/10.1016/j.apnu.2023.10.008
A commentary by a psychiatric mental health nurse practitioner (PMHNP), Susan Glodstein, who became a volunteer responder with 988 Lifeline in the United States. She is advocating for PMHNP students to receive training as 988 Lifeline Crisis Counselors.
Abstract – The 988 Suicide and Crisis Lifeline (hereinafter referred to as The Lifeline) is a national effort to provide mental health crisis support for individuals or 3rd parties (requesting help for others) via a three-digit phone number. Since July 2022, the Lifeline is part of a national effort to assist individuals who are suicidal, homicidal, or distressed. Over half of suicides in the United States are completed with a gun, hence the need for an effort to focus on prevention related to a growing tragic loss of life. Psychiatric mental health nurses can be part of the prevention focus by promoting and discussing The Lifeline resource with patients, families, and colleagues. The majority of individuals requiring psychiatric-mental health services are living in the community and not institutionalized; therefore, The Lifeline is an invaluable resource to support wellness and well-being.
Becker-Haimes, E.M. et al. (2023). Mobile crisis services: A clinician survey of current suicide prevention practices and barriers to care delivery. Community Mental Health Journal. https://doi.org/10.1007/s10597-023-01208-9
Mobile crisis team clinicians were surveyed about screening and assessment tools, strategies to address suicide risk, and what they perceive as barriers to providing quality mobile crisis services.
Abstract – Mobile crisis teams (MCTs) deploy clinicians to assist individuals in acute crisis in the community. Little is known about the extent to which these teams provide evidence-based practices (EBPs) for suicide prevention nor the barriers they face. We surveyed 120 MCT clinicians across the United States about their: (1) use of suicide risk screening and assessment tools; (2) strategies used to address suicide risk (both EBPs and non-EBPs); and (3) perceived barriers to high-quality MCT services. Nearly all clinicians reported use of validated suicide screening tools and generic “safety planning.” However, a sizeable minority also reported use of non-EBPs. Open-ended responses suggested many client/family-, clinician-, and systems-level barriers to MCT use of EBPs for suicide prevention. We identified several targets for future implementation efforts, including the need for de-implementation strategies to reduce use of ineffective and potentially harmful practices, and unique aspects of MCTs that require tailored implementation supports.
Cho, H-s. & Bae, S-M. (2024). The moderated mediating effect of community integration in depressive symptoms which are related to childhood adversity and suicide attempts by adolescents who have dropped out of school. Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2023.107324
Data from the 2013 Longitudinal Survey and Support Plan for Dropouts in South Korea were used to analyze the mediating effects of community integration on the experiences of childhood adversity. In turn, the authors sought to see these effects on depressive symptoms and suicide attempts for those adolescents who have dropped out of school.
Abstract – The aim of this study was to verify the moderated mediating effect of community integration on the influence of childhood adversity on suicide attempts in adolescent who have dropped out of school and examine the mediating effect of depressive symptoms. This study used the data of the first year from a Longitudinal Survey and Support Plan for Dropouts in 2013. Among 776 respondents, 685 (mean age = 18.04, SD = 0.78) participants were included in the final analysis. The results of this study showed that both childhood adversity and depressive symptoms were positively associated with suicide attempts. Depressive symptoms mediate the relationship between childhood adversity and suicide attempts. In particular, the mediating effect of depression on the influence of childhood adversity on suicide attempts was moderated by community integration. The results of this study suggest that help from counselors and social workers at a national level is needed to strengthen social ties between out-of-school youth and community members to prevent suicide among youth who have dropped out of school.
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