Research Roundup – January 2023
This is a summary of the latest Canadian (🇨🇦) and international suicide research we collected in the past month:
🇨🇦 Benny, C. et al. (2023). Investigating the association between income inequality in youth and deaths of despair in Canada: A population-based cohort study from 2006 to 2019. Journal of Epidemiology and Community Health, 77, 26–33. http://dx.doi.org/10.1136/jech-2022-219630
“Deaths of despair” refer to deaths by suicide, drug overdose and alcohol-related liver disease. They are increasingly experienced by young adults. This study examines the relationship between these deaths among young Canadians and income inequality.
Abstract– Background: Deaths due to suicide, drug overdose and alcohol-related liver disease, collectively known as ‘deaths of despair’, have been markedly increasing since the early 2000s and are especially prominent in young Canadians. Income inequality has been linked to this rise in deaths of despair; however, this association has not yet been examined in a Canadian context, nor at the individual level or in youth. The study objective was to examine the association between income inequality in youth and deaths of despair among youth over time. Methods: We conducted a population-based longitudinal study of Canadians aged 20 years or younger using data from the Canadian Census Health and Environment Cohorts. Baseline data from the 2006 Canadian Census were linked to the Canadian Vital Statistics Database up to 2019. We employed multilevel survival analysis models to quantify the association between income inequality in youth and time-to deaths of despair. Results: The study sample included 1.5 million Canadians, representing 7.7 million Canadians between the ages of 0 and 19 at baseline. Results from the weighted, adjusted multilevel survival models demonstrated that income inequality was associated with an increased hazard of deaths of despair (adjusted HR (AHR) 1.35; 95% CI 1.04 to 1.75), drug overdose (AHR 2.38; 95% CI 1.63 to 3.48) and all-cause deaths (AHR 1.10; 95% CI 1.04 to 1.18). Income inequality was not significantly associated with suicide deaths (AHR 1.23, 95% CI 0.93 to 1.63). Conclusion: The results show that higher levels of income inequality in youth are associated with an increased hazard of all-cause death, deaths of despair and drug overdose in young Canadians. This study is the first to reveal the association between income inequality and deaths of despair in youth and does so using a population-based longitudinal cohort involving multilevel data. The results of this study can inform policies related to income inequality and deaths of despair in Canada.
🇨🇦 Dhari, S. et al. (2023). Anchoring to life: A photovoice study of resiliencies among sexual and gender minority women post-suicide attempt. SSM Qualitative Research in Health. https://doi.org/10.1016/j.ssmqr.2023.100219
The authors conducted qualitative interviews with 11 Canadian-based sexual and gender minority (SGM) women who had experience with a suicide attempt. The aim was to uncover the strengths and resiliencies of these women post-attempt.
Abstract– Lesbian, bisexual, trans, queer, and other sexual and gender minority (SGM) women are at high risk of suicide. Stigma, discrimination, and exclusion are known risk factors. Contrasting longstanding trends of risk-focused research, this study examines the experiences of SGM women who have attempted suicide focusing on their embodied strengths and resiliencies to continue living post-attempt. Qualitative data from Photovoice methods and in-depth interviews with 11 Canadian-based women who survived a suicide attempt were collected in 2017. Analysis involved an inductive, reflexive thematic approach informed by the minority strengths model. The analysis generated three interconnected themes: 1) reconciling identities and traumas, 2) anchoring to life, and 3) staying afloat: blending professional- and self-help. First, participants described the importance of reconciling past traumas and coming to terms with – and embracing – their SGM identities to live well post-attempt. Second, participants emphasized the potential for community supports to facilitate connectedness, belonging, and a sense of purpose following a suicide attempt. Importantly, this “anchoring” to community also provided a key outlet through which SGM women could process and mitigate experiences of mental health hardship, thereby directly buffering against suicidality. Third, participants underscored that staying afloat post-attempt was a journey requiring persistent and proactive efforts, including use of effective self-management strategies and professional mental-health services. Taken together, these findings offer important insights into the strengths and resiliencies of SGM women who have attempted suicide to guide the efforts of mental health practitioners and the design and evaluation of tailored suicide prevention programs.
🇨🇦 Epp, D. et al. (2022). Maintaining safety while discussing suicide: Trauma informed research in an online focus group. International Journal of Qualitative Methods. https://journals.sagepub.com/doi/epub/10.1177/16094069221135973
Online focus groups in six Canadian provinces were conducted to study and discuss research of suicide in rural communities. A major goal of these focus groups was to create and sustain a safe environment for focus group participants.
Abstract– Although trauma informed (TI) care has been well researched and is used in many disciplines, TI practices for research are less developed. In this article, we explore the use of TI practices when discussing the sensitive topic of suicide within an online focus group. Qualitative studies on rural suicide are sparse, even though the incidence of suicide is higher rurally than in urban areas. Rural communities are often close knit and stigma can be greater toward non-normative experiences such as mental illness and suicide. Due to the nature of rural communities, the trauma of suicide can affect many people. We conducted focus groups with rural community participants who had an interest in suicide prevention to explore the gaps in rural suicide research and the best methods for knowledge dissemination of existing research. Steps were taken to mitigate re-traumatization and/or severe distress in the participants through a TI research approach. An online video conferencing platform became necessary due to the COVID-19 pandemic. The online features promoted safety and transparency by: enabling participants to turn off camera and microphone if they became distressed, allowing them time to self-regulate until feeling sufficiently safe to return to the focus group discussion; leaving the discussion at any time with little disruption; and being able to choose a comfortable place to join the discussion. Other TI activities included ensuring ongoing consent throughout the process, recruiting through a third party to enhance safety, having support resource lists tailored to the region, and encouraging participants to share and debrief final thoughts. A number of participants commented on feeling safe within the environment of the focus group. Limitations included challenges identifying distress online and technological difficulties associated with rural internet services. To our knowledge, this is the first article using a TI approach for discussing suicide through an online method.
🇨🇦 Liu, L. et al. (2023). Pandemic-related impacts and suicidal ideation among adults in Canada: A population-based cross-sectional study. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 43(3). https://doi.org/10.24095/hpcdp.43.3.01
The Public Health Agency of Canada (PHAC) and Statistics Canada surveyed Canadian adults on the effects of COVID-19 on mental health. The authors examined the survey data to gauge the prevalence of suicidal ideation.
Abstract– Introduction: Recent evidence has suggested that there has been an increase in suicidal ideation during the COVID-19 pandemic. Our objectives were to estimate the likelihood of suicidal ideation among adults in Canada who experienced pandemic-related impacts and to determine if this likelihood changed during the pandemic. Methods: We analyzed pooled data for 18 936 adults 18 years or older who responded to two cycles of the Survey on COVID-19 and Mental Health collected from 11 September to 4 December 2020 and from 1 February to 7 May 2021. We estimated the prevalence of suicidal ideation since the pandemic began and conducted logistic regression to evaluate the likelihood of suicidal ideation by adults who experienced pandemic-related impacts, and by factors related to social risk, mental health status, positive mental health indicators and coping strategies. Results: Adults who had adverse pandemic-related experiences were significantly more likely to experience suicidal ideation; a dose–response relationship was evident. People who increased their alcohol or cannabis use, expressed concerns about violence in their home or who had moderate to severe symptoms of depression, anxiety or posttraumatic stress disorder also had significantly higher risk of suicidal ideation. The risk was significantly lower among people who reported high self-rated mental health, community belonging or life satisfaction, who exercised for their mental and/or physical health or who pursued hobbies. Conclusion: The COVID-19 pandemic has influenced suicidal ideation in Canada. Our study provides evidence for targeted public health interventions related to suicide prevention.
Magness, C. et al. (2023). Changes in gatekeeper beliefs following ASIST and relation to subsequent gatekeeper suicide prevention behaviors. Community Mental Health Journal. https://doi.org/10.1007/s10597-022-01084-9
The authors look at the suicide-related beliefs and behaviours of 435 ASIST participants. These responses were measured both pre- and post- ASIST training.
Abstract – This study examines relations between suicide prevention gatekeeper beliefs and actual helping behaviors following participation in Applied Suicide Intervention Skills Training (ASIST). Participants (n = 434) completed measures examining suicide-related beliefs and behaviors using a naturalistic pre-post design. All beliefs demonstrated significant change from pre- to posttest. Regression analyses indicate that beliefs about perceived barriers to action and the controllability of suicide predicted identification of high-risk youth; perceived barriers to action were also negatively related to helping responses and referrals 6–9 months post training. Self-efficacy was not related to suicide prevention behaviors at follow-up. The importance of anchoring training curriculums and measurement to health behavior change theories is discussed.
🇨🇦 Nisbet, J. et al. (2022). Suicidal ideation, planning and attempts among Canadian coast guard and conservation and protection officers. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph192316318
This study investigates past year and lifetime estimates of suicidal ideation, planning, and attempts among Canadian Goast Guard personnel and Canadian Conservation and Protection Officers. 385 individuals were surveyed.
Abstract–The current study provides estimates of suicidal ideation, planning, and attempts among Canadian Coast Guard personnel and Canadian Conservation and Protection Officers. Participants (n = 385; 59% men) completed a self-report survey that collected past-year and lifetime estimates of suicidal ideation, planning, attempts, sociodemographic information, and symptoms related to mental health disorders. Within the sample, participants reported lifetime suicidal ideation (25.7%), planning (10.9%), and attempts (5.5%). Participants reported past-year suicidal ideation (7.5%), planning (2.1%), and the percentage of attempts was too marginal to report due to ethical considerations. Canadian Coast Guard personnel and Conservation and Protection Officers reported higher percentages of past-year and lifetime suicidal ideation, planning, and attempts than the Canadian general population, but the percentages reported are comparable to other Canadian PSP sectors. No statistically significant results were observed for the sociodemographic covariates within the past-year, whereas, statistically significant results were observed for the lifetime sociodemographic covariates of age, province of residence, and previous work experience. There were statistically significant associations between past-year suicidal ideation and positive screens for major depressive disorder (MDD) and general anxiety disorder (GAD); as well, past-year suicidal planning was associated with social anxiety disorder (SAD). There were also statistically significant associations between lifetime suicidal ideation, planning, and attempts and positive screens for posttraumatic stress disorder (PTSD), MDD, and SAD. Lifetime suicidal ideation and planning were associated with panic disorder (PD). The current estimates provide valuable information for clinicians and stakeholders involved in prevention programs, treatment, or future research.
O’ Rourke, H. et al. (2023). Sexual and gender identity and note-leaving among adult suicide decedents in the USA. BJPsych Open. https://doi.org/10.1192/bjo.2022.610
A study comparing the practice of note-leaving among the adult sexual and gender minority (SGM) population who die by suicide with non-SGM adult suicide decedents.
Abstract–Background: Suicide is one of the leading causes of preventable death in the USA, representing a critical public health threat. Suicide risks differ for different populations. In particular, the sexual and gender minority (SGM) population remains at increased risk for suicide. One of the circumstances that may differ for SGM and non-SGM individuals is the propensity to leave a suicide note. Information regarding note-leaving may be helpful in informing suicide prevention and intervention. Aims This study documents the differences in note-leaving in SGM individuals compared with non-SGM individuals, using recent data from the National Violent Death Reporting System (N = 98 515) and accounting for important covariates. Methods: We fit a logistic regression model with SGM status and covariates predicting note-leaving in suicide. Results SGM decedents were 1.508 times more likely to leave a note than their non-SGM counterparts, controlling for demographic, mental health and substance use covariates. Conclusions These findings highlight the importance of tailoring suicide prevention and intervention efforts to meet the needs of SGM populations.
🇨🇦 Post, E. et al. (2023). The clinical utility of spirituality and religion in meaning-making theory for suicide loss survivors: A scoping review. Religions. https://doi.org/10.3390/rel14010073
This review looks at suicide loss survivors and the use of spirituality, religion, or meaning-making in their bereavement process.
Abstract–In the case of violent/traumatic loss due to a completed suicide, there can be an overwhelming and complicated grief reaction followed by a spiritual need for the process of sense making and finding meaning. Some emerging literature on suicide loss survivors (SLSs) denotes that suicide loss is more similar to other forms of bereavement but is uniquely characterized by high levels of shame, guilt, self-blame, and stigma. This article examines themes within the current literature on the bereavement process, meaning-making theory, religion, and spirituality. The aim of this scoping review was to consider the question concerning the clinical utility of accompanying meaning-making interventions with a spiritually informed approach for SLS. The research was conducted through a scoping review. Records were identified through database searches of ProQuest (N = 93); OMNI (N = 184); and EBSCO (N = 63). Through a process involving identification, screening, and eligibility guided by inclusion and exclusion criteria, a total of 25 (N = 25) articles were used. These articles were analyzed in-depth for commonalities. Grief experiences, religious and spiritual experiences and meaning-making were three themes that emerged from the literature. In conclusion, this review elevates the importance of an integrated clinical counselling approach that encourages meaning-making within the context of spirituality to promote positive psychotherapy outcomes and growth for SLSs.
🇨🇦 Saxena, S. et al. (2023). Self-harm emergency department visits in Canada during the COVID-19 pandemic: Evidence from a sentinel surveillance system. Injury Epidemiology, 10(1), 1. https://doi.org/10.1186/s40621-022-00411-8
The authors culled self-harm emergency department visitation data from the Canadian Hospitals Injury Reporting and Prevention Program database from 2018 to 2020. They compared 2020 data to a pre-pandemic baseline in 2018-2019 to determine any changes in self-harm cases.
Abstract–Background: Self-harm is a leading cause of morbidity and mortality globally, though the prevalence tends to be highest among adolescents. As an indicator in suicide surveillance, the incidence of self-harm is useful because it is sensitive to social, environmental, and economic conditions. During the COVID-19 pandemic, the epidemiology of self-harm has varied across contexts. This study aims to investigate the changes in self-harm emergency department visits in 2020 compared to a pre-pandemic period in 2018-2019. Methods: Self-harm emergency department visits were extracted from the Canadian Hospitals Injury Reporting and Prevention Program database from 2018 to 2020. We compared the data in 2020 with the pre-pandemic baseline in 2018-2019. We examined the changes in volume, the percentages of self-harm cases among all intentional injuries by sex, age group, and the proportions of self-harm cases by method of injury. We also quantified the time trends of the percentages of self-harm cases among all intentional injuries using Joinpoint regression. Results: The overall volume of emergency visits related to self-harm was higher in 2020 during weeks 24-51 compared to the average volumes for the same weeks of 2018-2019. Percentage of self-harm among all intentional injury emergency department visits was significantly higher by 6.1% among females (p < 0.05) and by 5.3% among males in 2020 than in 2018-2019 (p < 0.05). The 11-to-18-year age group showed an increase in the percentage of self-harm among all intentional injury emergency department visits by 7.4% in 2020 when compared to 2018-2019. Time trend analyses showed that the percentages of self-harm among all intentional injury emergency department visits were higher during weeks 4-52 in 2020 than in 2018-2019, for both males and females. Conclusions: The percentage of emergency department visits related to self-harm among all intentional injury visits were higher during 2020 than in 2018-2019. These results underscore the importance of continued surveillance of self-harm in Canada to better understand the sociodemographic factors affecting self-harm and to inform the prevention strategies and policies.
Schlichthorst, M. et al. (2022). Evaluating the components of national suicide prevention strategies. Crisis. https://doi.org/10.1027/0227-5910/a000887
A review of 24 countries with a national suicide prevention strategy. 12 components of these strategies were analyzed.
Abstract–Background: National suicide prevention strategies support development of suicide prevention activities and their evaluation. Aims: potential contribution of individual components to reduce suicide rates. Methods: We conducted a narrative review and statistical analysis of national suicide prevention strategies. The narrative review was based on a framework of 12 components and included 29 countries (14 lower middle-income countries [LMICs] and 15 high-income countries [HICs]) with a national suicide prevention strategy. The statistical analyses covered suicide mortality data for 24 countries with a national strategy (9 LMICs and 15 HICs). Results: The number of components adopted in national strategies ranged from 4 to 11, and training and education were included in 96.5% of strategies. Estimated period effects for total suicide rates in individual countries ranged from a significant decrease in the yearly suicide rate (RR = 0.80; 95% CI 0.69–0.93) to a significant increase (RR = 1.12; 95% CI 1.05–1.19). There were no changes in suicide mortality associated with individual components of national strategies. Limitations: The limitations of existing suicide mortality data apply to our study. Conclusion: Further detailed evaluations will help identify the specific contribution of individual components to the impact national strategies. Until then, countries should be encouraged to implement and evaluate comprehensive national suicide prevention strategies.
🇨🇦 Taylor, P. (2022). Enduring and distancing: A grounded theory and photovoice study about women’s help-seeking for suicidality in the wake of intimate partner violence. Journal of Family Violence. https://doi.org/10.1007/s10896-022-00445-y
32 women with a history of intimate partner violence were interviewed and asked of their experiences with suicidal behaviours and how they sought help.
Abstract–Purpose: Intimate partner violence and women’s suicidality are known to be positively correlated; however, behaviour patterns and processes on managing these experiences are not well known. The purpose of this study was to understand how women with a history of intimate partner violence seek help for suicidality through an exploration of women’s perspectives on the opportunities and barriers to getting help. Methods: A qualitative grounded theory and photovoice study using a critical theory philosophical underpinning was used to understand women’s experience seeking help for suicidality within health services. One-to-one interviews occurred with 32 women from [Area of Country], 7 of whom participated in 5 group meetings where they shared self-generated photos that reflected their experiences. Interview and photovoice meeting transcripts were analyzed with a grounded theory approach. Results: Women sought to Feel Human by Enduring and Distancing, a way of managing System Entrapment or a sense of dehumanization from health care providers’ invalidation. Women Endured unfair treatment to avoid bothering health care providers and Distanced from the system to protect against invalidation even if it means not having access to professional help. Patterns of Enduring System Entrapment and Distancing from the System was found to parallel ways of managing coercive control from an abusive partner, named Abuser Entrapment, and managing hopelessness related to suicidality, named Trauma Entrapment. Conclusion: Trauma and violence informed interventions are discussed, including using a relational approach to understanding how the use of self, the environment, and systemic structures influences women’s capacity to continue living.
Vega, L. et al. (2023). Firefighter suicide: A theoretical model for a specific behavioral autopsy program. Omega-Journal of Death and Dying. https://journals.sagepub.com/doi/abs/10.1177/00302228231151278
This is a protocol proposal for a behavioural autopsy for firefighter personnel who die by suicide.
Abstract–Some research suggests that firefighters are possibly at greater risk than other at-risk first responder/public service populations for suicidality (e.g., police, Veterans, active duty military non-deployed males; Martin et al., 2017; Stanley et al., 2015; Stanley et al., 2016). Behavioral autopsies have been utilized to elucidate the clinical picture of other at-risk populations; however, to date there is no proposed or applied model for a suicide behavior autopsy in fire personnel. Developing a standardized suicide behavior autopsy will allow for a comprehensive understanding of firefighters who die by suicide and highlight potential areas for intervention. The aim of this paper is to integrate best practices for autopsy procedures from other high-risk populations into a comprehensive theoretical model for a proposed behavioral health autopsy for firefighters. Our recommended protocol is presented along with relevant limitations, clinical implications, and recommendations for future research.
Weiss, S.J. et al. (2022). Potential paths to suicidal ideation and suicide attempts among high-risk women. Journal of Psychiatric Research,155, 493–500. https://doi.org/10.1016/j.jpsychires.2022.09.033
Women attempt suicide more than men. This study examines the factors associated with suicidal ideation and attempted suicide among women.
Abstract–Although men are more likely to die by suicide, women experience a greater and more rapidly increasing rate of suicidal ideation (SI) and are 3 times more likely to attempt suicide than men. Despite this increased risk, little is known about factors that contribute to SI or suicide attempts (SA) among women. We examined factors associated with SI and SA among women and identified mood-related symptoms that differentiate women who reported attempting suicide from those who did not. Women at elevated risk for depression from across the U.S. (N = 3372; age 18 to 90) completed a survey regarding depression, anxiety, sociodemographic and reproductive status, behavioral/mental health history, and exposure to adversity. Structural equation modeling and logistic regression were used to analyze the data. Variables with the most significant relationships to SI were severity of depression (OR = 5.2, p = 0.000) and perceived stress (OR = 1.18, p = 0.000) while frequency of suicidal thoughts (OR = 3.3, p = 0.000), family history of a depression diagnosis (OR = 1.6, p = 0.000) and exposure to violence (OR = 1.9, p = 0.000) had the strongest association with SA. Childhood abuse/trauma was associated with SA (OR = 1.13, p = 0.000) but not SI. ‘Feeling bad about themselves, a failure, or having let themselves or their family down’ was the symptom that most clearly differentiated women who attempted suicide from women who reported suicidal ideation but no SA. The salience of childhood abuse and domestic/community violence to women’s risk for a suicide attempt reinforces previous findings that these adversities may differentiate suicide risk for women versus men. Continued research is essential to understand varied paths that may lead to suicidal behavior among women, some which appear unrelated to the frequency or intensity of their suicidal thoughts.
🇨🇦 Whitley, R. & Antebi, L. (2023). Canadian news media coverage of suicide during the COVID‑19 pandemic. Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-023-02430-2
The authors examined articles written during the first year of the COVID-19 pandemic to measure adherence to responsible suicide reporting guidelines. They compared 103 articles about suicide in the COVID-19 context with 457 articles about suicide in a non-COVID 19 context.
Abstract–Purpose: The COVID-19 pandemic led to concerns about increases in suicidal behaviour. Research indicates that certain types of media coverage of suicide may help reduce suicidality (the Papageno effect), while other types may increase suicidality (the Werther effect). This study aimed to examine the tone and content of Canadian news articles about suicide during the first year of the pandemic. Methods: Articles about suicide from Canadian news sources were collected and coded for adherence to responsible reporting of suicide guidelines. Articles which directly discussed suicidal behaviour in the COVID-19 context were identified and compared to other suicide articles in the same period. Lastly, a thematic analysis was conducted on the sub-sample of articles discussing suicide in the COVID-19 context. Results: The sub-set of articles about suicide in the COVID-19 context (n = 103) contained significantly more putatively helpful content compared to non-COVID-19 articles (n = 457), such as including help information (56.3% Vs 23.6%), quoting an expert (68.0% Vs 16.8%) and educating about suicide (73.8% Vs 24.9%). This lower adherence among non-COVID-19 articles is concerning as they comprised over 80% of the sample. On the plus side, fewer than 10% of all articles provided monocausal, glamourized or sensational accounts of suicide. Qualitative analysis revealed the following three themes: (i) describing the epidemiology of suicidal behaviour; (ii) discussing self and communal care; and (iii) bringing attention to gaps in mental health care. Conclusion: Media articles about suicide during the first year of the pandemic showed partial adherence to responsible reporting of suicide guidelines, with room for improvement.
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