Research Roundup – February 2020
This is a summary of the latest significant Canadian (🇨🇦) and international suicide research we collected in the past month:
Abiragi, M. et al. (2020). Importance and approach to manner of death opinions in opioid-related deaths. Journal of Forensic Sciences, 0, 1-6. DOI.org/10.1111/1556-4029.14266
The current opioid epidemic has magnified the issue of ambiguity surrounding a death by overdose—is it suicide (intentional overdose) or unintentional overdose? This study and the accompanying case study provide insight into the ongoing discussion and proposes a “5-point checklist” that may assist in delineating between the two death outcomes.
Abstract: The majority of opioid-related deaths are accidental. However, the number of opioid-related suicidal deaths is likely under recognized. Presented here is a case of suicide by heroin overdose. The manner of death would have likely been deemed accidental if not for critical information shared by the decedent’s family during follow-up telephone interviews between the forensic pathologist and the decedent’s family, which included text messages that were sent by the decedent just before his death that were not known at the time of the initial medicolegal death scene investigation. This case highlights that when a forensic pathologist establishes an engaged relationship with the decedent’s family, the information elucidated can prove to be invaluable in reaching an informed opinion about the manner of death. For overdose cases, identifying an accurate manner of death allows the design of public health efforts that adequately address the health risks in the community. For aid in the determination of the manner of death for overdose cases, we propose a five-step checklist that may assist forensic pathologists and medicolegal death investigators when approaching similar cases.
(🇨🇦) Gentil, L. et al. (2020). Predictors of emergency department visits for suicidal ideation and suicide attempt. Psychiatry Research DOI.org/10.1016/j.psychres.2020.112805
Research on the over-burdened health care sector in Canada, including presentations of suicidal behaviours in emergency departments, is much needed. This study posits ideas that may help curtail ED visits for suicidal ideation and suicide attempts.
Abstract: Objectives – This study investigated predictors of emergency department (ED) visits for suicidal ideation and suicide attempt in 2014–15 among patients at six Quebec emergency departments (ED), using administrative data. Methods – Participants (n = 11,778) used ED for suicidal ideation (30.4%); suicide attempt (7.0%); or other reasons (61.7%). A multinomial logistic regression was performed using variables described by the Andersen Behavioral Model. Results – The odds of ED visits for suicidal ideation or suicide attempt was high for adjustment disorders, personality disorders, and prior ED consultations for mental health (MH) reasons, but lower for schizophrenia spectrum and other psychotic disorders, illness acuity levels 3–5 (low severity), and 3+ consultations with outpatient psychiatrists. The odds of visiting ED for suicidal ideation increased in depressive disorders, and in the 12–17 year age range, but decreased in association with 1–2 outpatient psychiatrist consultations. The odds of suicide attempt also increased with alcohol use disorders and drug-induced disorders, but decreased with specific MH interventions at local community health services centers. Conclusion – Increasing access to ambulatory care, and care continuity in outreach programs for acute MH disorders, including substance-related disorders, may reduce ED visits for suicidal ideation and suicide attempt, while improving overall service delivery.
Green, A. et al. (2019). Suicidality disparities by sexual identity persist from adolescence into young adulthood.New York: The Trevor Project
An important study by The Trevor Project, the preeminent suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people. The paper includes important data on sexual and gender minority youth in the United States, who are at higher risk for suicidal behaviours than their cisgender counterparts.
Abstract: Significant increases in suicide deaths have occurred over the past 10 years in the U.S., particularly among adolescents and young adults (Curtin & Heron, 2019). However, suicide can be prevented through comprehensive public health strategies aimed at reducing risk factors and increasing protective factors (The Trevor Project, 2019a). Increased knowledge about populations at highest risk for suicide can assist prevention efforts aimed at ending suicide and enhancing well-being for those individuals. National prevalence data on lesbian, gay, and bisexual (LGB) high school students, collected as part of the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior Surveillance System (YRBS), indicate that LGB youth are more than four times as likely to attempt suicide compared to straight peers (Kann et al., 2018). Recently, the CDC released a report focused on transgender high school students, with similar disparities found in suicidality among transgender compared to cisgender students as between LGB and straight students (Johns et al., 2019). Further, The Trevor Project’s 2019 National Survey on LGBTQ Youth Mental Health found that 39% of LGBTQ youth ages 13–24 reported seriously considering suicide in the previous 12 months (The Trevor Project, 2019b). Among adults, individuals ages 18–25 have the highest rates of suicide attempts (Substance Abuse and Mental Health Services Administration, 2019). Thus, there is an urgent need to understand suicide disparities among LGB young adults ages 18–25, including how they compare to findings among high school students. In 2015 the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH) included questions on sexual identity for the first time. The NSDUH is currently the only national-level dataset to use probabilistic sampling and include questions on both sexual identity and suicidality among this age group. This report is the first to compare findings on suicidality among LGB youth ages 18–25 to those among LGB U.S. high school students, including the provision of adjusted odds ratios to assess suicidality risk among LGB youth compared to straight peers.
(🇨🇦) Heisel, M. et al. (2020). Meaning-centred men’s groups: Initial findings of an intervention to enhance resiliency and reduce suicide risk in men facing retirement. Clinical Gerontologist.
DOI.org/10.1080/07317115.2019.1666443
Retirement can be an especially daunting and stressful life event and can be an added risk factor for suicide for some men. Meaning-Centred Men’s Groups (MCMG) is an upstream initiative to help prevent or contain suicide risk and build resiliency for men recently retired or expected to retire soon.
Abstract: Objectives – To assess the preliminary effectiveness of Meaning-Centered Men’s Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement. Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors. Results – Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation. Conclusions – Preliminary findings suggest that MCMG is a novel men’s mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation. Clinical Implications – Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.
Jacob, L. et al. (2020). Fast food consumption and suicide attempts among adolescents aged 12-15 years from 32 countries.Journal of Affective Disorders.
DOI.org/10.1016/j.jad.2020.01.130
Adolescent suicide rates have risen in recent years in some countries like the United States (and slightly risen for girls and young women in Canada). This study looks at fast food consumption as a possible correlating factor for this elevation.
Abstract: Background – We examined the fast food consumption-suicide attempt relationship among 105,061 adolescents aged 12–15 years from 32 countries. Methods – This study was based on cross-sectional data from the Global School-based Student Health Survey (GSHS), and included 4 low-income, 13 lower middle-income, 9 upper middle-income, and 6 high-income countries. Data on past 7-day fast food consumption and 12-month suicide attempts were collected. The association between fast food consumption and suicide attempts was investigated with multivariable logistic regression and meta-analysis while adjusting for sex, age, food insecurity (proxy of socioeconomic status), alcohol consumption, smoking, physical activity, obesity, carbonated soft drink consumption, and fruit and vegetable consumption. Results – Overall, the prevalence of fast food consumption was high (53.5%) and the proportion of suicide attempts was higher among consumers of fast food compared to non-consumers (11.8% vs. 8.3%). Of the 32 countries included in the study, a positive association between fast food consumption and suicide attempts was found in 26 countries although this was not statistically significant in all countries. The pooled OR (95% CI) based on a meta-analysis was 1.31 (1.17–1.46). Limitations – Since this was a cross-sectional study, it is not possible to draw any conclusions about causality or temporality in the associations assessed. Conclusions – Fast food consumption is positively associated with suicide attempts in adolescents. Further research of longitudinal design is needed to confirm/refute our findings and explore the potential underlying mechanisms.
(🇨🇦) Katz, C. et al. (2019) Predictive validity of the MINI suicidality subscale for suicide attempts in a homeless population with mental illness.Suicide and Life-Threatening Behavior.
DOI.org/10.1111/sltb.12544
The homeless population in Canada is at greater risk for suicidal ideation and attempted suicide than the general population. This Canadian study examines the utility of the Mini Neuropsychiatric Interview(MINI) for suicide attempts among the homeless with a co-occurring mental disorder.
Abstract: Objective – Suicide is a leading cause of death, yet the accurate prediction of suicidal behavior is an elusive target for clinicians and researchers. The current paper examines the predictive validity of the Mini Neuropsychiatric Interview (MINI) Suicidality subscale for suicide attempts (SAs) for a homeless population with mental illness. Methods – Two thousand two hundred and fifty‐five homeless individuals with mental illness across five Canadian cities enrolled in the At Home/Chez Soi Housing First trial interviewed at baseline using the MINI Suicidality subscale with 2‐year follow‐up of self‐reported SAs. Results – Two thousand two hundred and twenty‐one participants were included in the analysis. High rates of mood and substance use disorders were present (56.5% and 67.4%, respectively). The mean MINI Suicidality subscale score was 7.71. Among 1,700 participants with follow‐up data, 11.4% reported a SA over the 2‐year study period. MINI Suicidality subscale scores were predictive of SAs (AUC ≥ 0.70) among those with and without a history of SAs, even among those with missing answers. A positive predictive value of 0.20 and a negative predictive value of 0.95 were demonstrated, with a relatively low number needed to assess of 4.5‐5. Conclusion – The MINI Suicidal subscale shows promise as an easy to use and accurate suicide risk prediction tool among homeless individuals with mental illness.
Kerr, B. et al. (2020). Assessing the usability, appeal, and impact of a web-based training for adults responding to concerning posts on social media: Pilot suicide prevention study. Journal of Medical Internet Research Mental Health.
DOI.org/10.2196/14949
Youths increasingly encounter distressing and disconcerting messages on social media which can adversely affect their mental health. An hour-long training, designed for adults to better support Indigenous youth who post or view such messages, was evaluated in this study.
Abstract: Background – Suicide prevention remains challenging among youth, as many do not disclose suicidal ideation. Nearly one-third of American Indian and Alaska Native (AI and AN, tribal, or native) youth see concerning messages on social media at least weekly. Objective – To prepare adults to support AI and AN youth who post or view concerning messages, our team designed an hour-long training: Responding to Concerning Posts on Social Media. This study tested the usability, appeal, and impact of the training. Methods – A purposive sample of 70 adults was recruited to participate in the pilot, which included 2 study arms. Arm 1 participants completed a 30-min training video and reviewed accompanying handouts, including the Viewer Care Plan (VCP). The VCP provided a 3-step planning and response tool: (1) Start the Conversation, (2) Listen, Gather Information, and Assess Viewer Experience, and (3) Plan and Act. The intent of the VCP was to support and connect AI and AN youth who either view or post concerning messages on social media to life-saving resources. Those enrolled in arm 2 participated in an additional interactive role-play scenario with a coach that took place after the training, via text message. Participants provided qualitative and quantitative feedback on the training’s relevance, appeal, and utility. Paired t tests were used to assess confidence in addressing concerning posts between pre- and postsurveys. Content analysis of the role-play transcripts was used to assess the quality and completion of the coached role-plays, in relation to the recommended VCP. Results – Altogether, 35 participants finished the training and completed pre- and postsurveys; 22 participants completed the 6-month follow-up survey. Pre-post analyses of differences in means found significant improvement across several efficacy measures, including confidence starting a conversation about social media (P=.003), confidence contacting the person who posted something concerning (P<.001), and confidence recommending support services to youth who view (P=.001) or youth who post concerning messages (P<.001). Similarly, pre- to 6-month analyses found significant positive improvement across multiple measures, including confidence contacting the youth who posted (P<.001), confidence starting a conversation about social media with youth (P=.003), and an increase in the number of experiences recommending resources for youth who viewed concerning social media posts (P=.02). Of the 3 steps of the VCP, the least followed step in coached role-plays was sharing tools and resources, which is a part of the third Plan and Act step. Conclusions – Findings indicate that the Responding to Concerning Posts on Social Media training is a promising tool to prepare adults to intervene and complete the VCP. Additional evaluation with a larger cohort of participants is needed to determine the unique impact of the role-play scenario and changes in mental health referral rates, behaviors, and skills.
(🇨🇦) Lee, J. et al. (2020). Outcome of pediatric emergency mental health visits: Incidence and timing of suicide. Canadian Journal of Emergency Medicine.
DOI.org/10.1017/cem.2019.470.
It has been found that in Canada and the United States the emergency departments of hospitals “are increasingly and disproportionately the center for youth mental health crisis”. It is important that more research is conducted on the risk of suicide for those evaluated in the ED. This British Columbia retrospective study looks at mental health visits to British Columbia Children’s Hospital pediatric ED between 2005 and 2015.
Abstract: Objectives – To determine the incidence, risk, and timing of mortality (unnatural and natural causes) among youth seen in a pediatric emergency department (ED) for mental health concerns, compared with matched non-mental health ED controls. Methods – This was a retrospective cohort study conducted at a quaternary pediatric ED in British Columbia. All visits for a mental health related condition between July 1st, 2005, and June 30th, 2015, were matched on age, sex, triage acuity, socioeconomic status, and year of visit to a non-mental health control visit. Mortality outcomes were obtained from vital statistics data through December 31st, 2016 (cumulative follow-up 74,390 person-years). Results – Among all cases in our study, including 6,210 youth seen for mental health concerns and 6,210 matched controls, a total of 13 died of suicide (7.5/100,000 person-years) and 33 died of suicide or indeterminate causes (44/100,000 person-years). All-cause mortality was significantly lower among mental health presentations (121.3/100,000 v. 214.5/100,000 person-years; hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.37-0.78). The median time from initial emergency visit to suicide was 5.2 years (interquartile range, 4.2-7.3). Among mental health related visits, risk of death by suicide or indeterminate cause was three-fold that of matched controls (HR, 3.05 95%CI, 1.37-6.77). Conclusions – While youth seeking emergency mental health care are at increased risk of death by unnatural causes, their overall mortality risk is lower than non-mental health controls. The protracted duration from initial presentation to suicide highlights the need for long-term surveillance and preventative care for youth seen in the ED for all mental health concerns.
Meuhlenkamp, J. et al. (2019). Short-and long-term impact of an undergraduate suicidology course. Suicide and Life-Threatening Behavior.
DOI.org/10.1111/sltb.12552
In the area of suicide and education there has been scant research devoted to post-secondary courses on suicide and suicide prevention. This study shows the positive impact a semester-long course can have for undergraduate students and their knowledge and attitudes toward suicide.
Abstract: Objective – Suicide prevention models emphasize the importance of education as a foundational element for success. Yet, courses on suicidology are rare and those that do exist focus on clinical intervention skills at the graduate level, missing a critical population of undergraduate students. The current study evaluated the short and long‐term impact of a semester long liberal education undergraduate course in suicidology. Method – Students enrolled in either the experimental (Understanding Suicide) or control course completed pre‐ post‐ and 4‐month follow‐up surveys assessing objective knowledge about suicide, suicide stigma, attitudes towards suicidal persons, and suicide prevention advocacy. Results – Mixed repeated measures ANCOVAs indicated significant interactions between course enrollment over time for all the outcome variables. Students in the suicidology course showed significant pre‐ to post‐ increases in knowledge and suicide prevention advocacy, alongside reductions in suicide stigma and negative attitudes compared to students in the control course, who showed no significant pre‐/post changes. All effects were maintained over time. Conclusion – Providing general education undergraduate courses in suicidology may be an important avenue for building a motivated and informed public that can sustain suicide prevention efforts in their communities.
(🇨🇦) Perret, L. et al. (2020). Cybervictimization in adolescence and its association with subsequent suicidal ideation/attempt beyond face-to-face victimization: A longitudinal population-based study. The Journal of Child Psychology and Psychiatry.
DOI.org/10.1111/jcpp.13158
It has been repeatedly shown that face-to-face victimization, including bullying, can be a risk factor for suicidal ideation and attempted suicide. Less is known of its electronic counterpart—cyberbullying. A study of suicidal ideation in adolescents victimized by cyberbullying. Data were culled from participants of Quebec Longitudinal Study of Child Development (QLSCD), a cohort of 2120 individuals followed from birth through the years 1997 to 2015.
Abstract: Background – Cross‐sectional associations have been documented between cybervictimization and suicidal risk; however, prospective associations remain unclear. Methods – Participants were members of the Quebec Longitudinal Study of Child Development (QLSCD), a prospective birth cohort of 2,120 individuals followed from birth (1997/98) to age 17 years (2014/15). Cybervictimization and face‐to‐face victimization experienced since the beginning of the school year, as well as serious suicidal ideation and/or suicide attempt were self‐reported at ages 13, 15 and 17 years. Results – In cross‐sectional analyses at 13, 15 and 17 years, adolescents cybervictimized at least once had, respectively, 2.3 (95% CI = 1.64–3.19), 4.2 (95% CI = 3.27–5.41) and 3.5 (95% CI = 2.57–4.66) higher odds of suicidal ideation/attempt after adjusting for confounders including face‐to‐face victimization, prior mental health symptoms and family hardship. Sensitivity analyses suggested that cybervictimization only and both cyber‐ and face‐to‐face victimization were associated with a higher risk of suicidal ideation/attempt compared to face‐to‐face victimization only and no victimization; however, analyses were based on small n. In prospective analyses, cybervictimization was not associated with suicidal ideation/attempt 2 years later after accounting for baseline suicidal ideation/attempt and other confounders. In contrast, face‐to‐face victimization was associated with suicidal ideation/attempt 2 years later in the fully adjusted model, including cybervictimization. Conclusions – The cross‐sectional association between cybervictimization and suicidal ideation/attempt is independent from face‐to‐face victimization. The absence of a prospective association suggested short‐term effects of cybervictimization on suicidal ideation/attempt.
Robinson, M.E. et al. (2020). Risk of psychiatric disorders and suicide attempts in emerging adults with diabetes. Diabetes Care.
DOI.org/10.2337/dc19-1487
Adolescents and emerging adults who have diabetes and their risk for psychiatric disorders has not been fully described in the academic literature. This paper found that both groups were more at risk for psychiatric disorders and potential suicidal behaviours than those without.
Abstract: Objectives – To determine the longitudinal risks of psychiatric disorders in adolescents and emerging adults with versus without diabetes. Designs and methods – We conducted a retrospective cohort study in Quebec, Canada, using linked health administrative databases of adolescents (age 15 years) with and without diabetes and without prior psychiatric disorders between 1997 and 2015, followed to age 25 years. Results – Our cohort included 3,544 individuals with diabetes and 1,388,397 without diabetes. Individuals with diabetes were more likely to suffer from a mood disorder (diagnosed in the emergency department or hospital) (adjusted hazard ratio 1.33 [95% CI 1.19-1.50]), attempt suicide (3.25 [1.79-5.88]), visit a psychiatrist (1.82 [1.67-1.98]), and experience any type of psychiatric disorder (1.29 [1.21-1.37]) compared with their peers without diabetes. Conclusions – Between the ages of 15 and 25 years, the risks of psychiatric disorders and suicide attempts were substantially higher in adolescents and emerging adults with versus without diabetes.
Ross, V. et al. (2020). A longitudinal assessment of two suicide prevention training programs in the construction industry. International Journal of Environmental Research.
DOI.org/10.3390/ijerph17030803
Mates in Construction is a pioneering Australian suicide awareness program geared toward the construction industry. Two different trainings that MIC offers were compared. General Awareness Training (GAT) was found to be more suitable for large to medium workplaces, while Mates awareness Training (MAT) is more conducive to smaller workplaces. Before, after, and follow-up surveys indicated both trainings are highly effective in improving suicide awareness and help-seeking intentions.
Abstract: As part of a suite of early intervention training and support services, Mates in Construction (MATES) provide two general awareness programs to promote mental health and suicide awareness and encourage help-offering and help-seeking in construction workers. General awareness training (GAT) is a one-hour session delivered to all construction workers on large to medium worksites, while MATES awareness training (MAT) maintains similar content but is of shorter duration and delivered informally to small workplaces. This study aimed to compare the effectiveness of the two programs using a before, after and follow-up design. Construction workers undertaking MAT or GAT training completed a short survey before and after their training and again at follow-up. Linear mixed-effect modelling indicated that GAT and MAT training provided similar results in improving suicide awareness and help-seeking intentions. Some variables showed a significant increase from pre-intervention to the three-month follow-up, indicating the long-term impact of some aspects of the training. The findings demonstrating the effectiveness of MAT training have important implications for MATES, as the training can be delivered to much smaller workplaces, making the program more widely available to the construction industry.
Huang, Y. et al. (2020). Abnormal brain activity in adolescents with Internet addiction who attempt suicide: an assessment using functional magnetic resonance imaging. Neural Regeneration Research.
DOI.org/10.4103/1673-5374.274346
A Chinese study of brain imaging among adolescent internet addicts and their association with attempted suicide.
Abstract: Internet addiction is associated with an increased risk of suicidal behavior and can lead to brain dysfunction among adolescents. However, whether brain dysfunction occurs in adolescents with Internet addiction who attempt suicide remains unknown. This observational cross-sectional study enrolled 41 young Internet addicts, aged from 15 to 20 years, from the Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, China from January to May 2018. The participants included 21 individuals who attempted suicide and 20 individuals with Internet addiction without a suicidal attempt history. Brain images in the resting state were obtained by a 3.0 T magnetic resonance imaging scanner. The results showed that activity in the gyrus frontalis inferior of the right pars triangularis and the right pars opercularis was significantly increased in the suicidal attempt group compared with the non-suicidal attempt group. In the resting state, the prefrontal lobe of adolescents who had attempted suicide because of Internet addiction exhibited functional abnormalities, which may provide a new basis for studying suicide pathogenesis in Internet addicts.
(🇨🇦) Taylor, P. (2020). System entrapment: Dehumanization while help-seeking for suicidality in women who have experienced Intimate Partner Violence. Qualitative Health Research, 30(4), 530-546.
DOI.org/10.1177/1049732319857671
There is growing evidence of a correlation between people experiencing Intimate Partner Violence (IPV) and exhibiting suicidal behaviours. This University of New Brunswick paper explores the negative impacts (including suicidal ideation and attempted suicide) women seeking help for IPV often encounter within health care systems.
Abstract: Attention to power imbalances when seeking help for suicidality after having been controlled within intimate partner violence (IPV) is crucial in improving health care delivery. Well documented in the literature is the correlation between suicidality and IPV and that help-seeking for each is difficult; however, a gap exists when both intersect. The process of women’s help-seeking is explored in this feminist grounded theory and photovoice multiple qualitative method study. Analysis of interviews with 32 women from New Brunswick, Canada, and photovoice meetings with seven women revealed a basic psycho-social problem. System Entrapment or being dehumanized while seeking help for suicidality occurred as a result of perceived invalidation from health care providers’ lack of empathy. Further harm while providing services to women feeling suicidal can be prevented with a shift from an individualist model toward a trauma and violence informed approach. Understanding the contextual factors influencing women’s suicidality may reduce victim blaming.