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

🇨🇦 Crawford, A. (2021). Advancing public mental health in Canada through a national suicide prevention service: Setting an agenda for Canadian standards of excellence. Canadian Journal of Psychiatry. 1-5. DOI: 10.1177/0706743721989153
Allison Crawford, Chief Medical Officer, Canada Suicide Prevention Service (CSPS), lists the priorities for suicide prevention in Canada, which include crisis line services. She offers evidence-based best practices for crisis line services and how “CSPS recognizes the importance of being guided by existing evidence as well as the opportunity to contribute to evidence, to lead innovation in suicide prevention, and to involve communities and people with lived experience in suicide prevention efforts.”

Abstract – The Public Health Agency of Canada is funding a new Canada Suicide Prevention Service (CSPS), timely both in recognition of the need for a public health approach to suicide prevention, and in the context of the COVID-19 pandemic, which is causing concern about the potential for increases in suicide. This editorial reviews priorities for suicide prevention in Canada, in relation to the evidence for crisis line services, and current international best practices in the implementation of crisis lines; in particular, the CSPS recognizes the importance of being guided by existing evidence as well as the opportunity to contribute to evidence, to lead innovation in suicide prevention, and to involve communities and people with lived experience in suicide prevention efforts.

🇨🇦 Iskric, A., Ceniti, A., Bergmans, Y., & McInerney, S. (2020). Alexithymia and self-harm: A review of nonsuicidal self-injury, suicidal ideation, and suicide attempts. Psychiatry Research. 288, 112920. DOI: 10.1016/j.psychres.2020.112920.
A Canadian study of the association between alexithymia, self-harming behaviours, and suicidal ideation.

Abstract – Introduction: Suicide attempts are a significant global public health concern. Research into non-traditional factors, such as the presence of alexithymia, may shed light on the prediction of suicidal behaviours, which can aid intervention and prevention strategies. To ascertain whether alexithymia is a unique risk factor for suicide attempts, this article reviews the evidence on alexithymia related to suicidal ideation, attempts, and non-suicidal self-injury (NSSI). Methods: A literature search was conducted for original articles examining the general and psychiatric populations. Results: There is consistent evidence linking alexithymia with suicidal ideation and NSSI, but inconsistent evidence linking it to suicide attempts. Conclusion: The relationship between alexithymia and suicidality seems to differ based on whether the research focuses on suicidal ideation, suicide attempts, or NSSI. The relationship between alexithymia and suicidality can be understood within the context of multiple code theory and childhood trauma. Future research should explore whether alexithymia can reliably distinguish between those with a single attempt and those with multiple suicide attempts as well as alexithymia levels pre- and post-intervention with suicide-related behavior as outcomes in treatment studies.

Amiri, S. (2021). Unemployment and suicide mortality, suicide attempts, and suicide ideation: A meta-analysis. International Journal of Mental Health. DOI: 10.1080/00207411.2020.1859347
A meta-analysis of 54 studies was conducted to gauge the association between unemployment and suicide death, suicide attempts, and suicide ideation.

Abstract – Objectives: A meta-analysis of 54 studies was conducted to gauge the association between unemployment and suicide death, suicide attempts, and suicide ideation. Unemployment and job loss are among the problems that have serious psychological consequences. This meta-analysis sought to investigate the impact of unemployment on suicidality and put it to comprehensive study and meta-analysis. Method: Mesh keywords were first extracted, and these were formulated to search in PubMed and Scopus. Searches were limited to English, and the search lasted until April 2020. The pooled odds ratio on the relationship between unemployment and suicidality was calculated. Several additional analyses were performed, including gender-based analysis and analysis based on suicide mortality, suicide attempts, and suicide ideation. All analyses were based on the random effects, and publication bias and heterogeneity analysis were performed. Result: Unemployment is associated with an increase odd of suicidality. This odd ratio (OR) is 1.85 and is in a confidence interval (CI) 1.55–2.20 (p < .001). Unemployment is associated with an increase odd of suicide mortality, and OR is 1.87 and CI 1.40–2.50 (p < .001). Also, unemployment is associated with suicide attempts (OR = 1.54; CI 1.26–1.89; p < .001) and suicide ideation (OR = 1.94; CI 1.61–2.34; p < .001). Unemployment in men is associated with increased odds of suicidality, and OR is 1.97 and CI 1.44–2.70 (p < .001). Also, unemployment in women is associated with suicidality (OR = 1.87; CI 1.48–2.37). Discussion: Overall, the findings of this study could be a clinical and health guide for professionals, as it provides a framework that examines one of the most important economic factors for suicidality.

🇨🇦 Varin, M., Orpana, H., Palladino, E., Pollock, N., & Baker, M. (2020).  Trends in suicide mortality in Canada by sex and age group, 1981-2017: A population-based time series analysis. Canadian Journal of Psychiatry, 66(2), 170-178. DOI:10.1177/0706743720940565
A study of suicidal death data culled from the Canadian Vital Statistics Death Database. The aim was to spot suicidal trends for different age and sex groups to identify opportunities for population-based and targeted interventions.

Abstract – Objectives: Suicide is a complex global public health issue. The objective of this study was to assess time trends in suicide mortality in Canada by sex and age group. Methods: We extracted data from the Canadian Vital Statistics Death Database for all suicide deaths among individuals aged 10 years and older based on International Statistical Classification of Diseases and Related Health Problems, Ninth Revision (E950-959; 1981 to 1999) and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (X60-X84, Y87·0; 2000 to 2017) for a 37-year period, from 1981 to 2017. We calculated annual age-standardized, sex-specific, and age group-specific suicide mortality rates, and used Joinpoint Regression for time trend analysis. Results: The age-standardized suicide mortality rate in Canada decreased by 24.0% from 1981 to 2017. From 1981 to 2007, there was a significant annual average decrease in the suicide rate by 1.1% (95% confidence interval, −1.3 to −0.9), followed by no significant change between 2007 and 2017. From 1981 to 2017 and from 1990 to 2017, females aged 10 to 24 and 45 to 64 years old, respectively, had a significant increase in suicide mortality rates. However, males had the highest suicide mortality rates in all years in the study; the average male-to-female ratio was 3.4:1. Conclusion: The 3-decade decline in suicide mortality rates in Canada paralleled the global trend in rate reductions. However, since 2008, the suicide rate in Canada was relatively unchanged. Although rates were consistently higher among males, we found significant rate increases among females in specific age groups. Suicide prevention efforts tailored for adult males and young and middle-aged females could help reduce the suicide mortality rate in Canada.

🇨🇦 Ishimo, M-C., Sampasa-Kanyinga, H., Olibris, B., Chawla, M., Berfeld, N., Prince, S., Kaplan, M., Orpana, H., & Lang, J. (2021). Universal interventions for suicide prevention in high-income Organisation for Economic Co-operation and Development (OECD) member countries: a systematic review. Injury Prevention, 0, 1–10. DOI:10.1136/injuryprev-2020-043975
A systematic review of effective universal interventions for suicide prevention. 100 studies were analyzed looking at interventions in the following areas: law and regulation reforms; physical barriers; community-based interventions; communication strategies; mental health policies and strategies; access to health care.

Abstract – Introduction: To examine the effectiveness of universal suicide prevention interventions on reducing suicide mortality in high-income Organisation for Economic Cooperation and Development (OECD) member countries. Methods: We implemented a comprehensive search strategy across three electronic databases: MEDLINE (Ovid), PsycINFO (Ovid) and Embase (Ovid). All studies using time-series, retrospective, prospective, pre– post or cross-sectional study designs were included. Studies were required to examine suicide mortality as the outcome of interest. To help organise the results, studies were grouped into six broad categories of universal interventions consistent with the World Health Organization (WHO) Comprehensive Mental Health Action Plan. A narrative synthesis of results was used to describe the findings. Results: Of the 15,641 studies identified through the search strategy, 100 studies were eligible in the following categories: law and regulation reforms (n=66), physical barriers (n=13), community-based interventions (n=9), communication strategies (n=4), mental health policies and strategies (n=7), and access to healthcare (n=1). Overall, 100% (13/13) of the included physical barrier interventions resulted in a significant reduction in suicide mortality. Although only 70% (46/66) of the law and regulation reform interventions had a significant impact on reducing suicide, they hold promise due to their extended reach. Universal suicide prevention interventions seem to be more effective at reducing suicide among males than females, identifying a need to stratify results by sex in future studies. Conclusions: These findings suggest that universal suicide prevention interventions hold promise in effectively reducing suicide mortality in high-income countries.

Smith, A., Reidy, D., & Norris, A. (2020). Teen dating violence and suicide risk among bisexual adolescents. Journal of Adolescent Health, 67(5), 685-691. DOI: 10.1016/j.jadohealth.2020.04.014
An under-researched area is the relationship between dating violence and suicidality among bisexual adolescents. The data for this study are drawn from the Youth Risk Behavior Surveillance Survey (YRBSS), a nationally representative sample of U.S. high-school students.

Abstract – Purpose: Suicide is a public health problem that disproportionately affects bisexual youth more than heterosexual, lesbian/gay, and other sexual minority youth. Teen dating violence (TDV) consists of physically, emotionally, and/or psychologically aggressive behavior in adolescent relationships and has been linked to increased suicidality among sexual minority youth. Although biological sex differences in suicide and TDV have been noted, limited research currently exists regarding the importance of these differences in bisexual youth. Methods: This study employed a cross-sectional descriptive design to investigate the relationship between biological sex, TDV, and suicide risk among bisexual youth in grades 9–12. This study used structural equation modeling to conduct a secondary analysis of pooled 2015 and 2017 national Youth Risk Behavior Surveillance Survey data that examined whether TDV mediated the relationship between biological sex and suicide risk among bisexual youth. Results: Results indicated that TDV did not mediate the relationship between biological sex and suicide risk among bisexual youth. Biological sex was a significant predictor of suicide risk with male youth reporting lower suicide risk than female youth, when controlling for dating history, TDV, age, and race. TDV predicted suicide risk, with youth reporting TDV having higher suicide risk, when controlling for dating history, biological sex, age, and race. In addition, black and Hispanic youth reported lower suicide risk compared to white youth.
Conclusion: There is a dire need for research that addresses issues of TDV and suicide among bisexual youth. Understanding factors influencing suicide risk following TDV experiences among bisexual youth will inform interventions to mitigate negative mental health outcomes.

🇨🇦 Geoffroy, P., Oquendo, M., Courtet, P., Blanco, C., Olfson, M., Peyre, H., Lejoyeux, M., Limosin, F., & Hoertel, N. (2020). Sleep complaints are associated with increased suicide risk independently of psychiatric disorders: Results from a national 3-year prospective study. Molecular Psychiatry. DOI: 10.1038/s41380-020-0735-3
In this Canadian paper, sleep complaints, including trouble falling asleep, early morning awakening, and hypersomnia, were studied to determine whether an association with suicide exists independent of psychiatric disorders.

Abstract – Prior research suggests that sleep disturbances are associated with increased risk of suicide. However, sleep disturbances are associated with a wide range of psychiatric disorders, and it is unknown whether this association is independent of psychopathology. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of three sleep complaints (i.e., trouble falling asleep, early morning awakening, and hypersomnia) on the 3-year occurrence of attempting suicide. Because psychiatric disorders increase the risk of suicide attempt almost exclusively through a general psychopathology factor representing their shared effect, covariates included that factor, prior history of suicide attempt, and a wide range of sociodemographic and clinical characteristics. The 3-year prevalence rate of suicide attempt was 0.6% (n = 241). Compared with participants who did not attempt suicide between the two waves, those who did reported significantly more frequently having trouble falling asleep (44.6% vs. 16.6%), early morning awakening (38.9% vs. 12.7%), and hypersomnia (35.0% vs. 10.7%). Following adjustments, effects of sleep complaints on this risk were significant and exerted almost exclusively through a general sleep complaints factor representing the shared effect across all sleep complaints. There were no residual associations of any individual sleep complaint with attempting suicide above that association. Sleep complaints are associated with an increased risk of attempting suicide independently of psychopathology and should be included in suicide risk assessments as these symptoms may provide targets for reducing the risks of suicidal behaviors.

Aiello, L., Dadashzadeh, S., Lynn, J., Starbird, W., Pawl, C., Aryee, S., & Haley, H. (2021). Using telemedicine to reduce suicide ideation and behavior: A systematic literature review. Telehealth and Medicine Today, 6(1). DOI: 10.30953/tmt.v6.226
There is an ever-increasing reliance on telemedicine defined as, “telecommunication technologies to provide medical information and support health care when distance separates the participants” to supplement heath care services. This systematic review looks at the efficacy of telemedicine to reduce suicidal ideation and behaviours.

Abstract – Objective: To review the published research for reported effectiveness of telemedicine in reducing suicide ideation and behavior in patients already diagnosed with a psychiatric disorder. Design: A thorough literature search on the PubMed, Web of Science, PsycInfo, Cochrane Library, and TRIP (Turning Research Into Practice) Medical Database was conducted. Phrases such as “telemedicine,” “telehealth,” “remote consultation,” “mobile health,” “psychiatric disorders,” “suicide,” “suicide, attempted or ideation,” and “telepsychiatry” were employed in a variety of combinations. The primary inclusion criteria encompassed peer-reviewed articles published in the past 5 years. Secondary inclusion criteria comprised: (1) the diagnosis of any psychiatric disorder for all patients included in the study, (2) the absence or presence of use of telepsychiatry to offer consultation and communication, and (3) reported outcomes involving suicide rates or attempted suicide rates. The research publications passing inclusion criteria were assessed, and all their corresponding outcome measures were included in a meta-analysis. Results: A total of 705 studies were identified by applying the initial search strategy to the electronic databases described. Of these, 205 passed the primary inclusion criteria. After excluding duplicates and non-English articles, 105 articles were screened using the secondary inclusion criteria. Nine articles remained, including three systematic reviews that were excluded. Finally, a total of six independent, non-overlapping studies were included in this meta-analysis, encompassing data for 576 participants. The 18 outcome measures in this meta-analysis included five “positive” measures: perceived ability to cope with suicidal ideation, optimism, gratitude, positive affect, and the Mini Mental State Exam. The “negative” measures included: suicidal ideation intensity, hopelessness, depression, suicidality, HAMD (Hamilton Depression Rating Scale) score, HAMD score without suicide item, medical admissions, number of days of medical hospitalizations, number of psychiatric hospitalizations, number of emergency room visits, suicide ideation questionnaire (SIQ) from baseline to posttreatment, and SIQ from baseline to follow-up. Overall, this review found support for the hypothesis that telemedicine can reduce suicide ideation and behavior. There was a moderate effect size for the 18 measures analyzed. Based on the four different forest plots presented in this analysis, all average effect sizes calculated showed that the intervention of telemedicine has a small-to-moderate effect on the measures studied, which translates loosely to a small-to-moderate effect on the patient’s suicide ideation and behavior. Conclusions: Telemedicine appears to be a promising way to reduce suicidal ideation, although how this translates into reductions in self-harm and/or suicide attempts is unclear from this review alone.

🇨🇦 Geoffroy, M-C., Orri, M., Girard, A., Perret, L., & Turecki, G. (2020). Trajectories of suicide attempts from early adolescence to emerging adulthood: Prospective 11-year follow-up of a Canadian cohort. Psychological Medicine, 1–11. DOI:10.1017/ S0033291720000732
The National Longitudinal Survey of Children and Youth is a prospective representative cohort of Canadian children between the years 1994-1995 and 2008-2009. It was used as a dataset in this study to gauge whether attempted suicide experienced in early adolescence persisted into early adulthood.

Abstract – Background: Suicide is a leading cause of mortality in youth, yet the course of suicide attempts is poorly documented. We explored the vulnerable transition from adolescence to emerging adulthood to identify group trajectories and risk factors. Methods: The National Longitudinal Survey of Children and Youth is a prospective representative cohort of Canadian children. We followed participants aged 7–11 years in 1994–95 to age 23 (2008–09). We modelled self-reported past-year suicide attempts (ages 12 to 23 years) using growth mixture models. We analysed risk factors from self- and parent-report questionnaires at pre-adolescence (ages 10–11) and early adolescence (ages 12–13) using multinomial logistic regressions. Analyses were adjusted for sample non-response and attrition. Results: In 2233 participants answering questions on teen and adult suicide attempts, we identified three trajectories: never attempted (96.0%), adolescence-limited (2.0%) and persisting into adulthood (2.0%). Adolescent girls aged 12–13 with depression/anxiety symptoms, and with mothers experiencing depression had higher risks of adolescence-limited than never-attempted [relative risk RR 9.27 (95% confidence interval: 1.73–49.82); 2.03 (1.02–3.32), for each standard deviation increase; 1.07 (1.00–1.15); respectively]. Preteen ADHD symptoms increased the risk of attempts persisting into adulthood as compared to never-attempted [RR 2.05 (1.29–3.28) for each standard deviation increase]. Suicide death of schoolmate/acquaintance increased risks of an adulthood trajectory as compared to never-attempted and adolescence-limited [RR 8.41 (3.04–23.27) and 6.63 (1.29–34.06), respectively]. Conclusion: In half the participants attempting suicide, attempts continued into adulthood. We stress the need for preventive strategies in early adolescence and differential clinical/educational interventions as identified for each trajectory.

Ortiz, S., Forrest, L., & Smith, A. (2020). Correlates of suicidal thoughts and attempts in males engaging in muscle dysmorphia or eating disorder symptoms. Journal of Clinical Psychology. DOI: 10.1002/jclp.23102
Studies have established a relationship between suicidality and body dysmorphic disorder and eating disorders (EDs). There is essentially no research, however, on a related disorder – muscle dysmorphia (MD) and suicide. This study addresses this issue.

Abstract – Objective: Despite the high rates of suicidality in body dysmorphic disorder and eating disorders (EDs), research on suicidality in a related disorder, muscle dysmorphia (MD), is essentially nonexistent. Thus, this study tested relations between suicidal thoughts and behaviors and MD and ED symptoms in an online male community sample. Method: A total of 464 males (Mage = 40.3; 85% Caucasian) recruited from Amazon’s Mechanical Turk completed measures that evaluated ED symptoms, MD symptoms, current suicidal ideation, and past suicide attempts. Results: Most MD and ED symptoms were correlated with current suicidal ideation and previous suicide attempts. In multivariate regression models, vomiting and appearance intolerance remained significantly related to suicidal ideation, while hard exercise and lower functional impairment were significantly related to prior suicide attempts. Conclusion: Results indicate that appearance dissatisfaction, a core MD criterion, and hard exercise, a common behavioral symptom of MD, are associated with suicidality.

Angoff, H., McGraw, J., & Docherty, M. (2020). Intersecting Identities and Nonsuicidal Self-Injury among Youth. Identity: An International Journal of Theory and Research. DOI:10.1080/15283488.2020.1863216
Research is inconclusive and inconsistent regarding the relationship of intersecting marginalized identities and nonsuicidal self-injury (NSSI). The relationship between the two is explored in this study.

Abstract – Recent research suggests that intersecting marginalized identities may be important in explaining suicide-related mental health disparities. However, inconsistent findings have emerged regarding nonsuicidal self-injury (NSSI). Guided by an intersectionality framework, we examined relations between identity and NSSI using a representative sample of 8th through 12th graders from Utah (N = 49,425). The independent influence of sexual orientation, gender, race/ethnicity, and religious preference on NSSI were examined using bivariate and multivariate logistic regression analyses. Intersectionality analyses, using two-way interaction terms, were then conducted to examine the impact of intersecting identities on NSSI. Results indicated that gay/lesbian, bisexual, and transgender and “other” gender youth, and non-Latter-day Saint (LDS) participants were at particularly high risk of NSSI. In intersectionality analyses, sexual minorities were more likely than heterosexual participants to endorse NSSI among cisgender, but not gender minority youth; bisexual participants of color were less likely to engage in NSSI than European American bisexual youth, but no effect for race/ethnicity was found for gay/lesbian youth; and among heterosexual participants, non-LDS youth were more likely than LDS youth to engage in NSSI, but no effect for religion was found among gay/lesbian or bisexual participants. Implications of these results and the differences in results by method are discussed.

Brock, S., Lieberman, R., Cruz, M., & Coad, R. (2021). Conducting school suicide risk assessment in distance learning environments. Contemporary School Psychology, 25, 3-11. DOI: 10.1007/s40688-020-00333-6
The COVID-19 pandemic has forced many schools to deliver instruction via distance learning. This has also meant that school mental health services, including suicide risk assessment, have needed to adapt to a remote approach.

Abstract – The social distancing mandate, implemented in response to the coronavirus disease 2019 (COVID-19) global pandemic, has guided many schools to deliver instruction via distance learning. Among the many challenges generated by this delivery system is the need for school mental health services, including school suicide prevention and intervention, to be conducted remotely. After briefly discussing the magnitude of the problem of youth suicide and how the COVID-19 pandemic has likely increased risk for youth suicidal ideation and behaviors, this article provides guidance on how school systems can prepare for and conduct suicide risk assessments in distance learning environments.

Long, M., Cerel, J., Aldrich, R. & Kheibari, A. (2021). Suicide exposure in crisis workers. Crisis. DOI: 10.1027/0227-5910/a000760
This is a study involving an online survey of crisis workers, determining exposure to suicide, the mental health implications of that exposure, and the “perceived professional preparedness for client suicide.”

Abstract – Background: Crisis workers provide services to individuals who are in acute distress. There is no research examining personal and occupational exposure to suicide in these workers. Aims: We aimed to examine the prevalence of personal, occupational, and colleague suicide exposure among crisis workers, the mental health outcomes associated with suicide exposures, and perceived professional preparedness for client suicide. Method: Crisis workers (n = 115) completed an online survey assessing suicide exposure, depression, anxiety, and posttraumatic stress disorder. Results: Over a third of participants (33.9%, n = 37) reported that they had lost at least one client to suicide, with an average of 2.30 clients (SD = 4.47) lost to suicide. Over three quarters (77.1%, n = 81) of study participants reported they had experienced at least one personal loss to suicide. Those who perceived their relationship to the personal suicide as close or very close had significantly greater PTSD symptoms (M = 3.29, SD = 2.23) than those who perceived their relationship as not at all close, not close, or somewhat close (M = 1.38, SD = 1.69), t(20) = −2.10, p = .049. Limitations: Snowball sampling is the study’s main limitation. Conclusion: The current study demonstrates that a substantial percentage of crisis workers are exposed to suicide and additional research is needed to determine how exposures impact practice and personal symptoms in this population.

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