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

🇨🇦 Oliffe, J., Ferlatter, O., Ogrodniczuk, J., Seidler, Z., Kealy, D., & Rice, S. (2021). How to save a life: Vital clues from men who have attempted suicide. Qualitative Health Research, 31(3), 415-429. DOI: 10.1177/1049732320975747
A study of the experiences and circumstances of men who have attempted suicide.

Abstract – Male suicide rates are high and rising, and important insights can be gleaned from understanding the experiences of men who have attempted suicide. Drawing from a grounded theory photovoice study of diverse Canadian men, three intertwined thematic processes were derived: (a) preceding death struggles, (b) life-ending attempts and saving graces, and (c) managing to stay alive post suicide attempt. Preceding death struggles were characterized by cumulative injuries, intensifying internalized pain, isolation, and participant’s efforts for belongingness in diminishing their distress. Men’s life-ending attempts included overdosing and jumping from bridges; independent of method, men’s saving graces emerged as changing their minds or being saved by others. Managing to stay alive post suicide attempt relied on men’s acceptance that their mental illness was unending but amenable to effective self-management with professional mental health care. The findings offer vital clues about how male suicide might be prevented.

🇨🇦 Whitley, R. (2021). The social determinants of male suicide. Men’s Issues of Men’s Mental Health, 22-43. DOI: 10.1007/978-3-030-86320-3_2
A piece by noted McGill professor Rob Whitley on the complex and varied landscape of male suicidality.

Abstract – Men account for approximately 75% of suicides in the western world, with male suicide rates particularly pronounced in certain groups of men, including: (i) middle-aged men; (ii) men living in rural and remote regions; (iii) White men; (iv) Indigenous men; (v) military veterans; and (vi) men involved in the criminal justice system. The reasons for suicide are complex, and suicide is rarely the result of a single factor. Instead, a combination of proximal and distal factors can interact over time to increase risk. Evidence suggests that some risk factors may be experienced much more intensely in men compared to women. In particular, the research literature indicates three powerful risk factors for male suicide, namely: (i) unemployment; (ii) divorce; and (iii) mental illness and substance use issues. Men experiencing these risk factors frequently face high levels of isolation, social stigma and financial strain leading to a weakening of social integration and connection, and a diminishing sense of meaning and purpose. Of note, male suicide rates have been rising steadily in the last 15 years, with several studies linking this rise to the 2007–2008 Global Financial Crisis and the subsequent Great Recession, which negatively affected many male-dominated industries.

🇨🇦 Ferlatte, O., Salway, T., Oliffe, J., Rice, S., Gilbert, M., Young, I., McDaid, L., Ogrodniczuk, J., & Knight, R. (2021). Depression and suicide literacy among Canadian sexual and gender minorities. Archives of Suicide Research, 25(4), 876-891. DOI: 10.1080/13811118.2020.1769783
2778 individuals identifying as sexual and gender minorities responded to an online survey measuring depression and its relationship with suicide literacy. The surveys included the 22-item depression literacy scale (D-LIT) and the 12-item literacy of suicide scale (LOSS).

Abstract – The purpose of this study was to examine and compare depression and suicide literacy among Canadian sexual and gender minorities (SGM). Online surveys comprised of the 22-item depression literacy scale (D-LIT) and the 12-item literacy of suicide scale (LOSS) were completed by 2,778 individuals identifying as SGM. Relationships between depression and suicide literacy and demographic characteristics were evaluated using multivariable linear regression. Overall, SGM correctly answered 71.3% of the questions from the D-LIT and 76.5% of the LOSS. D-LIT scores were significantly lower among cisgender men and D-LIT and LOSS scores were lower among transgender women when compared to cisgender women. LOSS and D-LIT scores were significantly lower among SGM without a university degree (compared to those with a university degree) and among SGM from ethnic minority groups (compared to White SGM). D-LIT scores, but not LOSS scores, were significantly lower among Indigenous SGM compared to White SGM. The findings provide evidence of differences in suicide and depression literacy between SGM subgroups along multiple social axes. Interventions to increase depression and suicide literacy should be prioritized as part of a mental health promotion strategy for SGM, targeting subgroups with lower literacy levels, including cisgender men, transgender women, Indigenous people, racialized minorities, and those without a university degree.

Sabrinskas, R., Hamilton, B., Daniel, C., & Oliffe, J. (2021). Suicide by hanging: A scoping review. International Journal of Mental Health Nursing. DOI:
A review of 36 studies focusing on hanging as a method of suicide and/or its prevention. The aim of the review is to better understand the contributing factors in the choice of this method and how to prevent it.

Abstract – Suicide by hanging is increasing in many countries around the world and whilst efforts are being made to influence the prevention agenda to reduce the incidence, little is known regarding the contributing factors for choosing this method. The purpose of this scoping review is to summate understandings about how the epidemiology and prevention of suicide by hanging is recognised, described, and discussed in the literature, and critically appraise the extent to which the lived-experiences of survivors of suicide attempts are included. A scoping review was conducted implementing the appropriate framework and in accord with the PRIMSA-ScR extension. Three databases (CINAHL, PubMed, and PsycINFO) were searched along with the reference lists of eligible sources in January and February 2021. Thirty-six articles with a primary focus on hanging as a method of suicide and/or its prevention are included in this review, with brief thematic analysis used to summarise the featured studies. Three distinct themes emerging from the literature include: (i) Hanging suicide deaths in the community environment or person’s usual place of residence, (ii) Hanging suicide deaths in controlled environments (including police cells, prisons, and inpatient units), and (iii) Medical management of near-lethal hangings. This review highlights the necessity for improving education and policy regarding the controlled environments frequently associated with hanging suicides and the medical management of near-lethal hangings, as well as the ongoing need for policy to guide and govern the responsible media portrayal of known suicides as well as fictional hangings. Finally, this review highlights the necessity for including those with lived-experiences of a suicide attempt by hanging to advance the current prevention agenda.

🇨🇦 Wilkes, C., Lewis, C., Brager, N., Bulloch, A., MacMaster, F., Paget, M., Holm, J., Farrel, S., & Ventriglio, A. (2021). Wellbeing and mental health amongst medical students in Canada. International Review of Psychiatry, 31(7-8), 584-587. DOI: 10.1080/09540261.2019.1675927
This study looks at the results of a survey of medical students at the Cumming School of Medicine, gauging their levels of wellbeing and mental health.

Abstract – Across the world there is significant evidence that medical students have high levels of mental ill-health and psychological distress with subsequent concerning effects on personal and occupational functioning. In Canada, recent studies have demonstrated worrying levels of burnout and depressive symptoms among practising doctors. In common with other countries, Canadian medical students are also subject to a high-pressure environment – with long clinical weeks and significant stressors – and these soon-to-be doctors have been previously shown to already demonstrate high levels of burnout. We surveyed 69 medical students at the Cumming School of Medicine, Calgary regarding their wellbeing and mental health. 26% of the students had been diagnosed with a mental health condition prior to medical school, while 36% reported currently seeing a professional regarding their mental ill-health, with anxiety disorders forming the most commonly reported conditions. 83% reported their studies as a significant source of stress. 22% tested as CAGE positive and a number of students reported using other substances. 70% of medical students met specified case criteria for exhaustion on the Oldenburg Burnout Inventory. These findings speak to the need for access to mental health services, evidence- or exhaustion on the Oldenburg Burnout inventory 74% met criteria for the GHQ questionnaire. Conclusions: These findings confirm that medical students are facing significant stressors during their training. These stressors include, in order of frequency, study, relational, financial, and accommodation issues. Nonprescription Substance use was a common finding as well as exhaustion and psychiatric morbidity. Future interventions pursued will have to address cultural issues as well as the organizational and individual determinates of stress.

Rochford, S., Dodd, P., & Austin, C. (2021). The public health approach to suicide prevention in Ireland. Irish Journal of Psychological Medicine. DOI: 10.1017/ipm.2021.72
This is a paper which examines public health approaches to suicide prevention. It includes a detailed look at Ireland’s current suicide prevention strategy, Connection to life.

Abstract – This article provides an overview of the public health approach to suicide in Ireland. The authors provide detail on the current suicide prevention strategy in Ireland, Connecting for Life, which is a whole-of-government, systemic, multicomponent national strategy. As the strategy enters its final extended phase of implementation over the period 2020–2024, the public health elements of Connecting for Life are presented, including the population level and more targeted approaches. The findings of an interim review of the strategy are discussed, in addition to the local and national implementation structures which are in place to assist implementation and monitoring of the strategy.

Khan Amiri, D., Norredam, M., Brande, S., Mittendorfer-Rutz, E., Nordentoft, M., & Erlangsen, A. (2021). Suicide and suicide attempts among asylum-seekers in Denmark. Archives of Suicide Research. DOI: 10.1080/13811118.2021.2011809
An analysis of suicidal behaviours among asylum seekers in Denmark from 2009-2019. Researchers culled data from immigration services and national registers.

Abstract – Objective: There are concerns that asylum-seekers are at increased risk of suicide attempt and suicide mortality. Yet, largescale nationwide studies are limited. Our aim was to examine whether asylum-seekers in Denmark had higher rates of suicide attempt and suicide when compared to the general population. Methods: A retrospective cohort design was used. Data on asylum-seekers and the general population living in Denmark during 2009–2019 were obtained from the Immigration services and national registers. Indirect standardization was applied to adjust for differences with respect to age group and sex and Incidence Rate Ratios (IRR) with 95% confidence intervals were calculated. Results: In a population of 78,666 asylum-seekers, a total of 60. There are concerns that asylum-seekers are at increased risk of suicide attempt and suicide mortality. Yet, largescale nationwide studies are limited. Our aim was to examine whether asylum-seekers in Denmark had higher rates of suicide attempt and suicide when compared to the general population. Methods: A retrospective cohort design was used. Data on asylum-seekers and the general population living in Denmark during 2009–2019 were obtained from the Immigration services and national registers. Indirect standardization was applied to adjust for differences with respect to age group and sex and Incidence Rate Ratios (IRR) with 95% confidence intervals were calculated. Results: In a population of 78,666 asylum-seekers, a total of 60 1 suicide attempts and 9 suicides were recorded. The rate of suicide attempt was 842.0 per 100,000 person-years for asylum-seekers and 92.3 per 100,000 person-years for the general population. When adjusting for differences related to age group and sex, an IRR of 8.5 (95% CI: 7.6−9.5) was found for suicide attempt between 2014-2019. The IRR for suicide attempt unaccompanied minors between 2015 and 2019 was 5.8 (95% CI: 4.3−7.5) when adjusting for age group. We did not find an elevated rate of suicide among asylum-seekers (IRR: 1.6, 95% CI: 0.6−3.5). Conclusions: Asylum-seekers were found to have higher rates of suicide attempt than the general population in Denmark. This also applied to unaccompanied minors. Our study emphasizes the need for awareness and preventive measures targeting mental health and suicidal behavior among asylum-seekers.

Cai, Z., Junus, A., Chang, Q., & Yip, P. (2021). The lethality of suicide methods: A systematic review and metanalysis. Journal of Affective Disorders, 300(1), 121-129.
This is a systematic review and metanalysis of studies looking at case fatality rates of different methods of suicide. The studies look at gender, age, and means of suicide.

Abstract – Background: The use of suicide methods largely determines the outcome of suicide acts. However, no existing meta-analysis has assessed the case fatality rates (CFRs) by different suicide methods. The current study aimed to fill this gap. Methods: We searched Scopus, Web of Science, PubMed, ProQuest and Embase for studies reporting method-specific CFRs in suicide, published from inception to 31 December 2020. A random-effect model meta-analysis was applied to compute pooled estimates. Results: Of 10,708 studies screened, 34 studies were included in the meta-analysis. Based on the suicide acts that resulted in death or hospitalization, firearms were found to be the most lethal method (CFR:89.7%), followed by hanging/suffocation (84.5%), drowning (80.4%), gas poisoning (56.6%), jumping (46.7%), drug/liquid poisoning (8.0%) and cutting (4.0%). The rank of the lethality for different methods remained relatively stable across study setting, sex and age group. Method-specific CFRs for males and females were similar for most suicide methods, while method-CFRs were specifically higher in older adults. Conclusions: This study is the first meta-analysis that provides significant evidence for the wide variation of the lethality of suicide methods. Restricting highly lethal methods.

Porter, J., Dabkowski, E., Connolly, O., & Prokopiv, V. (2021). Exploring mental health clinicians’ perceptions of the zero suicide initiative. International Journal of Mental Health Nursing. DOI: 10.1111/inm.12975
A qualitative study of mental health clinicians in Victoria, Australia. This gauged their perceptions toward the Zero Suicide Approach which had been introduced to a rural, regional community mental health team.

Abstract – Suicide continues to impact rural and regional families and communities across Australia and has become a key focus of healthcare, research, and government policy in recent years. The challenge for healthcare organizations is to translate policy visions and research for clinicians to effectively embed in day-to-day practice when supporting people who experience suicidal crisis. This study explored the introduction of an evidence-based Zero Suicide framework that includes a suicide prevention pathway and training package to a rural and regional community mental health team in Victoria, Australia. A qualitative semi-structured interview technique was used to explore the perceptions of mental health clinicians of the Zero Suicide approach, the training package and the barriers to inform its implementation across a specialist mental health service. Clinicians were complimentary of the intent of Zero Suicide and the training package and felt they had increased confidence in delivering suicide safe care. Four major themes were identified through thematic analysis: (i) Minimizing risk with realistic expectations; (ii) A good approach to making a difference; (iii) Lessons learnt; and (iv) Barriers to implementation needing to change culture. Overall participants identified the importance of continued regular suicide prevention training for all staff but also in tailoring it to different consumer and clinician needs. In addition, organizational structure and adequate staff resourcing were important to participants as was working within a safety culture.

Henn, M. Barber, C., Zhang, W., Staley, M., Azrael, D., & Miller, M. (2022). Identifying occupation groups for suicide prevention: A statewide data linkage study. Archives of Suicide Research. DOI: 10.1080/13811118.2021.2020699
This is a study identifying suicide rates by occupation in Utah. Data from the National Violent Death Reporting System (NVDRS) for the years 2005-2015 were used to determine sex and occupation-specific suicide death rates.

Abstract – Objective: To identify suicide rates by occupation category in Utah and describe the hospital history and circumstances of suicide decedents in the occupation category that had the state’s highest rate and highest number of suicides. Method: We used data on suicide decedents from the National Violent Death Reporting System (NVDRS) for 2005–2015 (n = 4,590) to calculate sex- and occupation-specific suicide rates among adults 18–65 years old in Utah. For working-age men who died by suicide during the years 2014–2015 (n = 623), we linked NVDRS data with decedents’ hospital histories. Results: One in five working-age men who took their life in Utah worked in Construction and Extraction, the single Bureau of Labor Statistics occupation category with both the highest number (n = 719) and rate of suicides (86.4/100,000 men vs. a range of 15.3–66.2 for other occupations). For females, there was no occupation group that had both high rates of suicide and high numbers of suicides compared with other occupations, so there was no clear occupation group to focus on in the same way there was for men. Using linked data for 2014–2015 deaths, 58% of men in Construction and Extraction who died by suicide had been diagnosed in the hospital in the past three years with a substance abuse or mental health problem, and a quarter (25%) tested positive for opioids on post-mortem examination. Nearly half (48%) of 2014–2015 male suicide decedents in Construction and Extraction were reported to have intimate partner problems, about a quarter (26%) had a criminal problem, a quarter (25%) were unemployed, and over half (54%) died by gunshot. Conclusions: Linked data identified Construction and Extraction as a potentially high-impact occupation group for suicide prevention and suggested potential contexts for intervention.

Stover, A., Lavigne, J., & Carpenter, D. (2021). A scoping review of suicide prevention training programs for pharmacists and student pharmacists. American Journal of Pharmaceutical Education, 85(10).
This review updates an earlier review of suicide prevention training programs for community and student pharmacists which was conducted in 2018. The authors note seven new suicide prevention programs targeting pharmacists since the original report.

Abstract – Objective: This scoping review updates a 2018 review of suicide prevention (SP) training programs for community and student pharmacists. Five scholarly databases were searched for articles published between January 2018 and December 2020. Articles were excluded if they: 1) did not describe an educational or training program for pharmacists or student pharmacists; 2) did not explicitly include suicide; 3) focused solely on attitudes; or 4) did not provide sufficient detail to evaluate program content. The quality of each study was examined using a quality assessment tool. Findings: Seven studies met inclusion criteria. Most trainings (86%) were delivered live with interactive, or role play scenarios to promote verbal and behavioral skill practice. About half (57%) assessed changes in knowledge and fewer programs (29%) assessed changes in communication. All assessed the ability to identify suicide warning signs and included referral resources. Six studies were assessed for quality; 67% had a rating of good, and 33% were rated as fair. Summary: Given the increase in suicide rates nationally, it is likely that pharmacists will encounter a patient in need of suicide prevention services. Since 2018, seven new SP training programs for community and student pharmacists have been reported, which demonstrates growing interest in SP training in the pharmacy profession. When integrated in PharmD curricula, trainings may help prepare the pharmacy workforce for encounters with patients in crisis. The impact of training on self-efficacy and communication skills warrants additional attention. Variation between programs should be evaluated to understand which instructional methods best prepare pharmacy professionals to engage in suicide prevention.

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