Research Roundup – February 2024
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month.
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Chaiyachati, K. (2023). As suicide prediction with artificial intelligence moves forward, barriers to implementation remain. Mayo Clinic Proceedings. https://doi.org/10.1016/j.mcpdig.2023.11.009
This commentary looks at the potential benefits and pitfalls of using artificial intelligence to predict suicide and suicidal behaviours.
Abstract – Screen for suicidality. This mantra was imprinted in me during medical school. My subconscious, however, asks me to reconsider. Omission bias stems from behavioral science. The human brain can desire inaction because the choice is perceived as easier and less risky. By avoiding the topic of suicidality—omission, a provider’s moral obligation to subsequently act or intervene is nonexistent. Blissful ignorance. By contrast, screening for suicidality, or commission, increases the risk of feeling at fault (or judged) for having asked about suicidality but then producing an inadequate safety plan or inadvertently introducing the thought of committing suicide when the thought was not previously there. Enter modern-day advances in artificial intelligence (AI). Natural language processing, large language models, and machine learning. These tools are being developed and tested in healthcare settings for a variety of use cases—including the prediction of suicide. AI’s perceived advantage is that it can be disentangled from behavioral biases, unmoved by fears of regret or failure. Trained correctly, AI can be immune to omission bias, operating with mechanical precision when predicting suicide.
Sinyor, M. et al. (2024). Changes in media reporting quality and suicides following national media engagement on responsible reporting of suicide in Canada. The Canadian Journal of Psychiatry. https://doi.org/10.1177/07067437231223334
A pre-post observational study of 450 suicide-related articles published in the Greater Toronto area was launched in 2015. It was a media engagement initiative to improve suicide-related reporting in Canada.
Abstract – Objective: Responsible media reporting is an accepted strategy for preventing suicide. In 2015, suicide prevention experts launched a media engagement initiative aimed at improving suicide-related reporting in Canada; its impact on media reporting quality and suicide deaths is unknown. Method: This pre–post observational study examined changes in reporting characteristics in a random sample of suicide related articles from major publications in the Greater Toronto Area (GTA) media market. Articles (n=900) included 450 from the 6-year periods prior to and after the initiative began. We also examined changes in suicide counts in the GTA between these epochs. We used chi-square tests to analyse changes in reporting characteristics and time-series analyses to identify changes in suicide counts. Secondary outcomes focused on guidelines developed by media professionals in Canada and how they may have influenced media reporting quality as well as on the overarching narrative of media articles during the most recent years of available data. Results: Across-the-board improvement was observed in suicide-related reporting with substantial reductions in many elements of putatively harmful content and substantial increases in all aspects of putatively protective content. However, overarching article narratives remained potentially harmful with 55.2% of articles telling the story of someone’s death and 20.8% presenting an other negative message. Only 3.6% of articles told a story of survival. After controlling for potential confounders, a nonsignificant numeric decrease in suicide counts was identified after initiative implementation (ω=−5.41, SE = 3.43, t = 1.58, p = 0.12). Conclusions: We found evidence that a strategy to engage media in Canada changed the content of reporting, but there was only a nonsignificant trend towards fewer suicides. A more fundamental change in media narratives to focus on survival rather than death appears warranted.
Arif, A. (2024). Suicide rates and risks across U.S. industries: A 29-year population survey. Archives of Suicide Research. https://doi.org/10.1080/13811118.2023.2300324
The authors look at suicide data from the National Health Interview Survey (NHIS)-Mortality from the years 1986 to 2015. They use these data to estimate suicide rates by industry in the United States.
Abstract – Objective: Suicide rates in the working-age U.S. population have increased by over 40% in the last two decades. Although suicide may be linked with characteristics of workplaces and their industries, few studies have reported industry-level suicide rates. No study has reported suicide rates by industry using nationally representative data. This study estimates suicide risks across industries in the U.S. working population. Methods: Industry-level estimates of suicide risks require substantial data; we combined 29 years of U.S. suicide data using the National Health Interview Survey (NHIS)-Mortality Linked data from 1986 through 2014, with mortality follow-up through 2015. We conducted survey-weighted Poisson regression analyses to estimate suicide mortality rates and rate ratios across all populations and stratified by gender. All analyses were adjusted first for age, and then for age, employment status, marital status, race/ethnicity, and rurality/urbanicity (demographic-adjusted). Rate ratios compared results for workers in each industry to those for all industries, accounting for the NHIS survey design. Results: A total of 1,943 suicide deaths were recorded. Age-adjusted suicide rates per 100,000 were highest in the furniture, lumber, and wood industry group (29.3), the fabricated metal industry (26.3), and mining (25.8). Demographic-adjusted rates were higher among men than women in most industries. Demographic-adjusted rate ratios were significantly elevated in the furniture, lumber, and wood industries (Rate Ratio, RR = 1.60, 95% confidence interval, CI = 1.18–2.18); chemicals and allied products (RR = 1.49, 95%CI = 1.04–2.13); and construction (RR = 1.21, 95% CI = 1.03–1.41). Conclusion: Several industries had significantly high suicide rates. Suicide prevention efforts may be particularly useful for workers in those industries.
Kirchner, S. & Neiderkrotenthaler, T. (2024). Experiences of suicide survivors of sharing their stories about suicidality and overcoming a crisis in media and public talks: A qualitative study. BMC Public Health. https://doi.org/10.1186/s12889-024-17661-4
In this study, focus groups were convened, consisting of suicide survivors who had publicly shared their stories of loss. In the groups, the participants related impressions of their story sharing experiences.
Abstract – Background: Media stories of hope and recovery from suicidal ideation have been found to have a positive impact on the audience, but little is known about how individuals who share their own experiences perceive the effects of their storytelling. This study aimed to assess qualitatively, through focus groups, how individuals who shared their personal story of hope and recovery in the media and public talks experienced the process, and which aspects they perceived as important in sharing their coping story. Methods: Three focus groups were conducted with a total of n = 12 individuals. These included n = 5 participants with experience of suicidal ideation or a suicide attempt, n = 4 individuals who had been bereaved through suicide, and n = 3 participants who experienced both. Participants were recruited from the American organisation “Suicide Survivors United”. Thematic analysis was used to assess the participants’ perception and experiences of sharing their story. Results: Participants shared that the intention to help others was the main motivation to share their story of hope and recovery. Participants noted many positive effects of their storytelling on themselves and also received positive feedback from the audience, such as improved help-seeking attitudes. The participants offered recommendations for those who want to share their story of hope and recovery, including careful personal preparation and media training before going public. They also discussed media recommendations for talking about suicide in the media. Conclusions: Sharing a personal story of hope and recovery may have a beneficial impact on the storytellers. Storytelling requires a careful preparation and training before going public and support and guidance is crucial in all stages of the storytelling, particularly to help unexperienced storytellers in going public and using their personal narratives to help prevent suicide.
Kheni, N. et al. (2023). Addressing suicide risk among immigrant women survivors of intimate partner violence. Issues in Mental Health Nursing. https://doi.org/10.1080/01612840.2023.2291685
Intimate partner violence is prevalent in the United States (and elsewhere) and can be associated with increased rates of suicidal ideation. This American study looks at this association among immigrant women, a very under-researched group.
Abstract – Intimate partner violence (IPV) is a significant public health problem contributing to multiple morbidities. Immigrant women who experience IPV may be disproportionately vulnerable to poor mental health outcomes, including self-harm and suicidal ideation, due to cultural experiences and contextual factors that prevent them from accessing services. While existing studies identify the risks for suicidal ideation amongst survivors of IPV, there is limited knowledge on how to tailor strategies to support immigrant women survivors of IPV who experience suicidal ideation. This study was conducted as part of the formative phase of a longitudinal research project designed to develop and evaluate a safety planning intervention for immigrant women survivors of IPV. Using qualitative in-depth interviews, we explored the perspectives of immigrant women survivors of IPV (n = 46) from various countries of origin, ages, and educational backgrounds on effective strategies for supporting immigrant women who disclose suicidal ideation. Study participants discussed various strategies for supporting survivors including building trust, providing encouragement, strengthening social support networks, and reminding survivors of parental responsibilities. Participants also pointed to the importance of the following services: domestic violence support, faith-based health resources, supportive immigration programs, mental health support, and emergency and medical treatment. These findings are informative for researchers and practitioners who work with immigrant women survivors of IPV, and they can be used to develop appropriate safety protocols and support strategies for survivors who are experiencing or have previously experienced suicidal ideation to mitigate the risk of self-harm.
Michalek, I. et al. (2024). Unveiling the silent crisis: Global burden of suicide-related deaths among children aged 10–14 years. World Journal of Pediatrics. https://doi.org/10.1007/s12519-023-00781-z
Data from Global Burden of Disease 2019 “were analyzed to investigate deaths and years of life lost (YLLs) due to suicide among children aged 10–14 years”.
Abstract – Background: The rise in suicides among children aged 10–14 years demands urgent attention globally. This study aims to assess the global burden of suicide-related deaths in this age group from 1990 to 2019, considering factors such as sex, geography, and sociodemographics, to inform prevention strategies and interventions. Methods: The data from Global Burden of Disease 2019, encompassing 204 countries and territories, were analyzed lost (YLLs) due to suicide among children aged 10–14 years. Statistical analyses, including mortality rates, YLLs, and the sociodemographic index (SDI), were conducted using standardized tools. Results In 2019, a total of 8327 [95% uncertainty interval (UI)=7073–9685] children aged 10–14 years died globally due to suicide, with a mortality rate of 1.30 (95% UI=1.10–1.51) per 100,000. The rates varied across countries/territories ranging between 0.05 (95% UI=0.02–0.10) in South Africa and 7.49 (95% UI=5.13–10.57) in Greenland. The contribution of suicide-related deaths to all-cause mortality ranged from 0.07% (95% UI=0.04%–0.15%) in South Africa to 33.02% (95% UI=24.36%–41.53%) in Greenland. Worldwide, there were approximately 636,196 (95% UI=540,383–740,009) YLLs due to suicide, with a rate of 99.07 (95% UI=84.15–115.23) per 100,000. The association between SDI and suicide-related deaths was evident, with higher contributions observed in countries with higher SDI. Conclusions: This study reveals a concerning global burden of suicide-related deaths among children aged 10–14 years. Despite progress in reducing mortality rates, suicide remains a significant issue. While overall rates have declined, the percentage of deaths caused by suicide in this age group is increasing.
Grunewald, W. et al. (2023). Development and validation of the fearlessness about suicide scale. Assessment. https://doi.org/10.1177/10731911231200866
Increasing research involving fearlessness about suicide, as opposed to fearlessness about death, is coming to the fore. This is one such study. The authors stress that this important distinction makes fearlessness about suicide a “more appropriate construct of measurement”. The project details the outcome of two studies from which a 7-item Fearlessness About Suicide Scale (FSS) emerged.
Abstract – Recent work has identified fearlessness about suicide, rather than fearlessness about death, as more theoretically relevant in the assessment of capability for suicide and thus a more appropriate construct of measurement. The aim of the current project was to develop and validate a scale specifically assessing fearlessness about suicide. Across two studies, support for a 7-item, single-factor structure of the Fearlessness About Suicide Scale (FSS) emerged. The FSS factor structure demonstrated a good fit in the first study and was replicated in the second study. Measurement invariance was examined across those identifying as men and women and found to be comparable. The FSS also demonstrated test–rest reliability and good convergent and divergent validity in community and undergraduate samples. Overall, findings indicate that the FSS has a replicable factor structure that generalizes across those identifying as men and women and may better assess components of capability for suicide than existing scales.
Jamieson, S.K. et al. (2024). Impacts of exposure to suicide of a military colleague from the lived experience of veterans: Informing postvention responses from a military cultural perspective. Death Studies. https://doi.org/10.1080/07481187.2023.2261408
The lived experiences of Veterans exposed to the suicide of a miliary colleague were sought in this American study. Qualitative analysis of 38 Veterans were collected and their perspectives compiled.
Abstract – Although exposure to the suicide death of a military colleague has been shown quantitatively to increase suicide risk factors among veterans, there are very few studies where veterans have been asked about this experience. This article presents a qualitative analysis of 38 interviews with U.S. veterans with exposure to the suicide death of a military colleague in past war operations. Participants described the impact of exposure in relation to the military context and official response to the death, which had long-term ramifications. Our findings suggest suicide prevention and postvention responses for veterans should be informed by the lived experience of veterans, including those for whom this experience occurred significantly in the past, as the impacts of different military policies and practices in response to suicide deaths over time are relevant to the impact of exposure to death of a military colleague in the short and long term.
Yu, H. et al. (2024). Perinatal depression and risk of suicidal behavior. JAMA Network Open, 7(1), e2350897. https://doi.org/10.1001/jamanetworkopen.2023.50897
A cohort study of perinatal depression (PND) was conducted in Sweden between 2001 and 2017. These data were used to identify those experiencing PND and then analysed to gauge associations with suicidal behaviours.
Abstract – Importance: Suicidal ideation is common among women with perinatal depression (PND). However, prospective data are limited on the risk, particularly long-term risk, of suicidal behavior (suicide attempt and completed suicide) among women with perinatal depression. Objective: To examine the association between PND and risk of short- and long-term suicidal behavior. Design, Setting, and Participants: A nationwide population-matched cohort study was conducted in Sweden including 86 551 women with PND from 2001 to 2017 and 865 510 unaffected women individually matched on age and calendar year at delivery. Sibling comparison was used to account for familial confounding. Data were analyzed from January 2022 to November 2023. Exposure: PND was identified through depression diagnosis or filled prescriptions of antidepressants from pregnancy to 1 year post partum in registers. Main Outcomes and Measures: All women were followed up for the first event of suicidal behavior recorded in registers. Hazard ratios (HR) of suicidal behavior were estimated using time-to-event analysis. Results: Women with PND (86 551 participants) received a diagnosis at a mean (SD) age of 30.67 (5.23) years. During a median (IQR) follow-up of 6.91 (3.62-10.88) years, 3604 events of suicidal behavior (incidence rate [IR], 5.62 per 1000 person-years) were identified among women with PND and 6445 (IR, 1.01 per 1000 person-years) among population-unaffected women. Women with PND had an elevated risk of suicidal behavior when compared with matched unaffected women (HR, 3.15; 95% CI, 2.97-3.35). Comparable, albeit somewhat attenuated, associations were yielded when comparing PND women with their PND-free sisters (HR, 2.75; 95% CI, 2.10-3.61). In the population-matched cohort, the association was greater for postnatal depression and among women without a history of psychiatric disorders. The excess risk was pronounced during the first year after diagnosis (HR, 7.20; 95% CI, 6.07-8.54), yet remained statistically significant during 5 to 18 years of follow-up (HR, 2.34; 95% CI, 2.12-2.57). Conclusions and Relevance: In this nationwide cohort study, women with PND were at an increased risk of suicidal behavior, particularly within the first year after diagnosis with persistent risk elevations throughout the 18 years of follow-up, highlighting the need for vigilant clinical monitoring of this vulnerable group.
Dalve, K. et al. (2024). Suicide-related behavior and firearm access among perpetrators of domestic violence subject to domestic violence protection orders. Preventive Medicine Reports, 37, 102560. https://doi.org/10.1016/j.pmedr.2023.102560
This is a study looking at perpetrators of domestic violence and their risk of suicide. In particular, those perpetrators who have been issued domestic violence protection orders (DVDOs) and had their firearms removed, are featured.
Abstract – Perpetrators of domestic violence (DV) may be a population at elevated risk of suicide. Domestic violence protection orders (DVPOs) can include the removal of firearms from the individual subjected to the order (i.e., the respondent) to protect the victim-survivor. While removal of firearms in a DVPO is designed to protect the victim-survivor; it may also prevent suicide of the respondent by reducing access to lethal means. Therefore, we examined the association of respondent suicide-related behaviors with firearm possession and weapon use in DV among a sample of granted DVPO petitions in King County, Washington (WA), United States from 2014 to 2020 (n = 2,537). We compared prevalence ratios (PR) of respondent firearm possession and use of firearms or weapons to threaten or harm by suicide-related behavior. Overall, respondent suicide-related behavior was commonly reported by petitioners (46 %). Approximately 30 % of respondents possessed firearms. This was similar between respondents with and without a history of suicide-related behavior (PR: 1.03; 95 % CI: 0.91–1.17). Respondents with a history of suicide-related behavior were 1.33 times more likely to have used firearms or weapons to threaten/harm in DV compared to those without a history of suicide-related behavior (44.1 % vs. 33.8 %; 95 % CI: 1.20–1.47). In conclusion, both firearm possession and suicide-related behaviors were common among DVPO respondents. History of suicide-related behavior may be a marker for firearm-related harm to the victim- survivor. Evaluations of DVPO firearm dispossession should consider both firearm-related injury of the victim-survivor and suicide of the respondent.
Phillips, J.G. et al. (2024). The search term ‘suicide’ is being used to lead web browsers to online casinos. Behaviour & Information Technology. https://doi.org/10.1080/0144929X.2023.2298307
This piece investigates the questionable practice of enticing web users to gambling sites when they use search terms such as “suicide”.
Abstract – While Search Engine Optimisation seeks to enhance PageRankings, some methods are not approved or condoned by browser developers. To understand the risks faced by suicidal gamblers in the online environment, 2 studies examined the behaviour of an online search engine. A series of Google searches in 2021 used key terms such as ‘suicide’ and ‘gambling’ that might be employed by a suicidal gambler. During these searches browser ‘hits’ included opportunities to gamble. Webpages (N = 200) offered to a potentially suicidal gambler were primarily categorised as: other suicides (20%), treatment providers (8.5%), online casinos (7%); politics (22%), academic (23.5%). From a Google search providing 1,090 hits, the links to 113 online casinos were classified as a function of Domain Name hijacking, Metatag Stuffing, Error 404, and presence of Malware. There were significant relationships between the size of the businesses whose Domain Names were hijacked, and the presence of Malware. The deliberate use by webpage designers of the word ‘suicide’ to attract customers to online casinos appears inappropriate and ethically questionable.
Kim, C. et al. (2024). Patterns of follow-up mental health care after hospitalization for suicide-related behaviors among older adults in South Korea. Journal of Affective Disorder, 350, 313-318. https://doi.org/10.1016/j.jad.2024.01.089
Older adults in South Korea who had been hospitalized for suicide-related behaviours were studied after hospital discharge for the follow-up mental heath care they received.
Abstract – Objective: This study aimed to investigate the sociodemographic and clinical factors associated with receiving follow-up mental healthcare within 7 days and 30 days after hospitalization for suicide-related behaviors (SRB) among older adults in South Korea. Methods: Data from the Korean National Health Information Database were used, including information on sociodemographic variables and healthcare utilization. The study cohort consisted of individuals born in 1950 or before with a prior hospitalization record for suicide attempts or probable suicide attempts. Logistic regression analysis was conducted to predict the odds of receiving follow-up care within 7 days and 30 days, adjusting for covariates. Results: Among the 37,595 older adults discharged from hospitalization for SRB, 29.13 % and 37.86 % received follow-up care within 7 days and 30 days, respectively. Follow-up care was more common among younger individuals, women, those with higher socio-economic status (SES), urban residents, and individuals with comorbidities. Conclusion: The provision of mental health follow-up care for older adults after hospitalization for suicide attempts is inadequate in South Korea. Increasing access to follow-up care among those with lower income, residing in rural areas, and older age is crucial. Public awareness campaigns, stigma reduction training for healthcare providers, and system-level changes, such as telemedicine and integrated care pathways, can help bridge the healthcare gap and reduce suicide mortality among older adults.