Research Roundup – January 2020

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

Kaufman et al. (2020).Effects of increased minimum wages by unemployment rate on suicide in the USA. Journal of Epidemiology and Community Health, 0, 1-6. DOI: 10.1136/jech-2019-212981
An American study examining the effect of the minimum wage on the suicide rate. There are few studies of suicide and its relationship to economic factors.

Abstract: Social welfare policies such as the minimum wage can affect population health, though the impact may differ by the level of unemployment experienced by society at a given time. The effect of a US$1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. Minimum wage increases appear to reduce the suicide rate among those with a high school education or less and may reduce disparities between socioeconomic groups. Effects appear greatest during periods of high unemployment.

Link et al. (2019). The burden of farmer suicide on farmer suicide on surviving family members: A qualitative study. Issues in Mental Health Nursing, 41(1), 66-72.
Research indicates that farmers are at an increased risk of suicide. This may be partly attributed to a lack of access to mental health services or fear of the stigma associated with receiving mental health services in a rural setting. There is a relative dearth of studies on farmer suicides despite their occupational high- risk designation. This is a timely addition, especially as it concerns surviving the surviving family members of farmers who have died by suicide, an even less-studied population than farmers themselves.

Abstract: The purpose of this descriptive qualitative study was to better understand the burden of farmer suicide on surviving family members. Themes included: (1) family members expressed guilt; (2) family members experienced symptoms of psychological distress; (3) family members felt attached to the land and chose to remain on the farm; (4) short-term coping mechanisms included family, friends and faith; (5) long-term coping mechanisms included acts of honoring their loved one; (6) there was a lack of awareness of community support resources following the suicide.

Chandler, A. (2019). Boys don’t cry? Critical phenomenology, self-harm, and suicide.The Sociological Review, 67(6), 1350-1366. DOI: 10.1177/0038026119854863
A UK qualitative study of white working-class men and self-harm and suicide. A social and cultural perspective is emphasized.

Abstract: In this article I argue that critical phenomenology, informed by critical race and intersectional scholarship, offers a useful lens through which to consider suicide and self-harm among men. To illustrate this, I draw on a narrative informed analysis of the accounts of 10 men who had experienced self-harm, read through Sara Ahmed’s queer phenomenology. Two themes are emphasised: gendered, raced, classed bodies that are (unexpectedly) stopped; and bodies that, despite being stopped, still ‘do’ – enacting violence and control against self and other. Critical phenomenology can support much needed examination of the complex ways in which socioeconomic class, race, gender and age structure experiences of distress among different social groups. This approach enables a simultaneous examination of the way that privilege and oppression may shape both the experience of distress, and the way it is responded to – including through violence against the self, and against others.

🇨🇦 Sinyor, M., Stack, S. & Niederkrothenthaler, T. (2019). What the highest rated movie of all time may teach us about portraying suicide in film. Australian & New Zealand Journal of Psychiatry, 1– 2 DOI: 10.1177/0004867419891247
A (partially) Canadian paper which looks at the portrayal of suicide in the film The Shawshank Redemption. An important piece which looks at both the positive and negative impacts fictional depiction of suicide can have at the population-level, often described as the Papageno Effect and the Werther effect.

Abstract: I guess it comes down to a simple choice, really. Get busy living or get busy dying. – Andy, The Shawshank Redemption. Media portrayals of suicide can have a substantial, negative influence on suicide rates often described as the Werther effect (Sinyor et al., 2018). One of the most extreme examples of this phenomenon was the publicity surrounding the death of Robin Williams which was associated with an increase of more than 1800 deaths in the United States in late 2014 (Fink et al., 2018). Recently, there has been renewed interest in the potential deleterious effects of fictional media depictions given an association between the release of the Netflix show 13 Reasons Why and increased youth suicides (Niederkrotenthaler et al., 2019).

Thoma et al. (2019). Suicidal disparities between transgender and cisgender adolescents. Pediatrics, 144(5).
Although there has been a great increase in transgender studies of late, more research in this area is needed. This study is significant as it includes differences within transgender adolescent subgroups, as well as comparisons with cisgender individuals.

Abstract: …Conclusions – In this study, we used comprehensive measures of gender assigned at birth and current gender identity within a large nationwide survey of adolescents in the United States to examine suicidality among transgender adolescents (TGAs) and cisgender adolescents (CGAs). TGAs had higher odds of all suicidality outcomes, and transgender males and transgender females had high risk for suicidal ideation and attempt. Authors of future adolescent suicidality research must assess both gender assigned at birth and current gender identity to accurately identify and categorize TGAs.

(Letter to the editor) Dagar et al. (2019). High viewership of videos about teenage suicide on Youtube. Journal of the American Academy of Child & Adolescent Psychiatry, 59(1), 1-4. DOI: 10.1016/j.jaac.2013.12.022
This is a study of how (teenage) suicide is portrayed through videos on YouTube, “the largest source of video-based digital content”, and the impact they have on teen viewership.

Abstract: The recent rise in suicide rate of teenagers has coincided with their increasing use of social media sites. YouTube is the social media platform most commonly used by teenagers. Recent research studies and news reports have highlighted serious concerns about the nature of information available on YouTube and its potential impact. Owing to such concerns, the aim of our study was to analyze videos about teenage suicide on YouTube and viewers’ engagement with them. We conducted a comprehensive search and analyzed unique videos in the English language with ≥1,000 views. The videos were categorized and compared based on their source. The tone of top 10 comments, based on viewer engagement, was analyzed as well. Statistical analysis, including Kruskal-Wallis tests to compare the videos, was conducted. The final analysis included 413 videos, with cumulative 482,736,217 views. Close to half (48.6%) of the videos were educational, and almost a third (29.3%) were about awareness/prevention of teenage suicide. Only 8.2% of videos were from academic sources. Among the 2,500 comments analyzed, 29.5% had a positive tone, and 7.5% expressed frank suicidal ideation or explicitly sought help against such thoughts. In conclusion, the extremely high viewership of videos on teenage suicide, which overwhelmingly convey a positive message, speaks to the demand for such content online and therefore reflects an online cry for help by teenagers. On the same note, this high demand also provides us a great opportunity to engage teenagers for suicide prevention through YouTube.

McManus, S. & Gunnell, D. (2019). Trends in mental health, non-suicidal self-harm and suicide attempts in 16-24 year old students and non-students in England, 2000-2014.Social Psychiatry and Psychiatric Epidemiology, 55, 125-128.
Post-secondary students and their mental health is a major topic of interest in suicide prevention. This is a UK study of the prevalence of common mental disorders (CMD), non-suicidal self-harm and attempted suicide among 16-24 year old students and non-students in England.

Abstract: There are concerns about high levels of mental ill-health amongst university students, but little is known about the mental health of students compared to non-students over time. Using data on young people (16–24) from three UK National Psychiatric Morbidity Surveys (2000, 2007, and 2014), we found no evidence that the overall prevalence of common mental disorder (CMD), suicide attempts, or non-suicidal self-harm (NSSH) differed between students and non-students, although there was an indication that CMDs rose markedly in female students between 2007 and 2014. A rise in NSSH is apparent in both students and non-students.

🇨🇦 Paris, J. (2019). Suicidality in borderline personality disorder.Canadian Medicina, 55(6), 223. DOI: 10.3390/medicina55060223
Abstract: Borderline personality disorder (BPD) is associated with suicidal behaviors and self-harm. Up to 10% of BPD patients will die by suicide. However, no research data support the effectiveness of suicide prevention in this disorder, and hospitalization has not been shown to be useful. The most evidence-based treatment methods for BPD are specifically designed psychotherapies.

Fazel, S. & Runeson, B. (2020). Suicide.New England Journal of Medicine, 382, 266-274.
This article is both a good introduction and reference piece for those interested in major issues and areas of research in suicidology. Sections include: Epidemiology, Risk Factors, Assessment of Suicide Risk, Interventions to reduce suicide risk and Integrating Assessment and treatment.

Abstract: Suicide accounts for approximately 1.5% of deaths per year worldwide. Risk factors are known for populations, and psychological models address individual risks; the models and tools for assessing suicide risk are imperfect but provide some guidance.

🇨🇦 Lake et al. (2020). Does cannabis use modify the effect of post-traumatic stress disorder on severe depression and suicidal ideation? Evidence from a population-based cross-sectional study of Canadians. Journal of Psychopharmacology, 34(2), 181-188.DOI: 10.1177/0269881119882806
An important Canadian study of the potential efficacy of cannabis use for sufferers of PTSD and treatment for their severe depression and suicidal ideation.

Abstract: Background – Post-traumatic stress disorder sharply increases the risk of depression and suicide. Individuals living with post-traumatic stress disorder frequently use cannabis to treat associated symptoms. We sought to investigate whether cannabis use modifies the association between post-traumatic stress disorder and experiencing a major depressive episode or suicidal ideation. Conclusions – This study provides preliminary epidemiological evidence that cannabis use may contribute to reducing the association between posttraumatic stress disorder and severe depressive and suicidal states. There is an emerging need for high-quality experimental investigation of the efficacy of cannabis/cannabinoids for the treatment of post-traumatic stress disorder.

Mikami et al. (2019). Gender differences in the suicide attempts of adolescents in emergency departments: Focusing on individuals with Autism Spectrum Disorder.Adolescent Psychiatry, 9, 232-240.
The relationship between autism and suicidal behaviours is an emerging issue in community mental health but thus far the research has been lacking. This Japanese study examines the gender differences in adolescent suicide attempters who presented to emergency departments and required subsequent hospitalization and also looked at the relationship and prevalence of Autism Spectrum Disorder among these attempters.

Abstract: Conclusion – Males were less likely to visit psychiatric service previous to attempting suicides, and may be likely to complete suicides. In addition, suicide attempters with ASD are characteristic in male, and likely to have comorbid adjustment disorder. ED visits offer a window of opportunity to provide suicide prevention interventions for adolescents, and therefore, psychiatrists in EDs have a crucial role as gatekeepers of preventing suicide reattempts, especially in adolescent males including individuals with ASD having adjustment disorder.

Hoffman et al.  (2020). Association of pediatric suicide with county-level poverty in the United States, 2007-2016.JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2019.5678
A significant American study of population-level suicide in relation to poverty.

Abstract: Conclusions and relevance – The findings suggest that higher county-level poverty concentration is associated with increased suicide rates among youths aged 5 to 19 years. These findings may guide research into upstream risk factors associated with pediatric suicide to inform suicide prevention efforts.

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