This is a summary of the latest significant Canadian (🇨🇦) and international suicide research we collected in the past month:
Opara, I., et al. (2020). Suicide among black children: An integrated model of the interpersonal-psychological theory of suicide and intersectionality theory for researchers and clinicians. Journal of Black Studies. 1-21. doi.org/10.1177/0021934720935641
An important study of the rise of suicide in recent years among black children in the United States.
Recently, research has reported that the rates of suicide among Black children between the ages of 5 to 12-years-old are increasing as they are now more likely to commit suicide than White children. Yet, there are very few, if any, frameworks being used by researchers to explain the risks of suicide among Black children. Suicide research has overwhelmingly been focused on White youth thus leaving a critical gap in suicide research. This conceptual paper provides an integrated framework using the Interpersonal-Psychological Theory of Suicide and Intersectionality theory, as a guide for researchers, clinicians, and practitioners to incorporate culturally appropriate techniques in their work as a way to prevent suicide among Black children. This framework highlights racial discrimination, mental health, socioeconomic status, and sexual/gender minority status to be the most preeminent, yet understudied factors leading to suicide risk among Black children in the United States.
🇨🇦 Langmann, C. (2020). Effect of firearms legislation on suicide and homicide in Canada from 1981 to 2016. PLoS ONE 15(6): e0234457. https://doi.org/10.1371/journal.pone.0234457
Means restriction is considered a best practice of suicide prevention. This paper looks at means restriction in the context of Canadian firearms legislation.
Canada implemented a series of laws regulating firearms including background and psychological screening, licensing, and training in the years 1991, 1994, and 2001. The effects of this legislation on suicide and homicide rates were examined over the years 1981 to 2016. Models were constructed using difference-in-difference analysis of firearms and non firearms death rates from 1981 to 2016. In addition, negative binomial regression was used to test for an association between rates of suicide by Canadian Province and firearms prevalence, using licensing rates as a proxy for prevalence. No associated benefit from firearms legislation on aggregate rates of male suicide was found. In men aged 45 to 59 an associated shift from firearms suicide after 1991 and 1994 to an increase in hanging resulted in overall rate ratios of 0.994 (95%CI, 0.978,1.010) and 0.993 (95%CI, 0.980,1.005) respectively. In men 60 and older a similar effect was seen after 1991, 1994, and 2001, that resulted in rate ratios of 0.989 (95%CI, 0.971,1.008), 0.994 (95%CI, 0.979,1.010), and 1.010 (95%CI, 0.998,1.022) respectively. In females a similar effect was only seen after 1991, rate ratio 0.983 (95%CI, 0.956,1.010). No beneficial association was found between legislation and female or male homicide rates. There was no association found with firearm prevalence rates per province and provincial suicide rates, but an increased association with suicide rates was found with rates of low income, increased unemployment, and the percentage of aboriginals in the population. In conclusion, firearms legislation had no associated beneficial effect on overall suicide and homicide rates. Prevalence of firearms ownership was not associated with suicide rates. Multifaceted strategies to reduce mortality associated with firearms may be required such as steps to reduce youth gang membership and violence, community-based suicide prevention programs, and outreach to groups for which access to care may be a particular issue, such as Aboriginals.
Copeland, W.E., et al. (2020). Associations of despair with suicidality and substance misuse among young adults. JAMA Network Open. 3(6):e208627. doi:10.1001/jamanetworkopen.2020.8627
A study of deaths of despair (suicides, drug overdoses and alcohol-related deaths) among the young adult population in the Great Smoky Mountains longitudinal study, 1992-2015.
Importance: Deaths of despair is a term that has recently been used to describe the increases in premature mortality from suicides, drug overdoses (particularly from opiates), and alcohol-related liver disease among US adults. Despite the use of the term despair, its role in these causes of premature death has not been empirically tested. Objective: To test whether despair among young adults is associated with suicidal thoughts and behavior, alcohol misuse, and drug misuse. Conclusions and Relevance: This study’s findings suggest an empirical basis for longitudinal associations between despair and several, but not all, precursors of “deaths of despair” in rural Appalachia. Individual despair should be studied as a potential factor associated with morbidity and impairment in young adulthood.
Joiner, T.E., et al. (2020). Might the COVID-19 pandemic spur increased murder-suicide? Journal of Aggression, Conflict and Peace Research. 12(3), 177-182. https://doi.org/10.1108/JACPR-05-2020-0502
Renowned suicidologist Thomas Joiner opines on the COVID-19 pandemic and its potential to affect rates of murder-suicide.
Purpose: The coronavirus 2019 (COVID-19) pandemic has prompted concerns about an increased risk for psychological distress, broadly and suicide mortality, specifically; it is, as yet, unclear if these concerns will be realized, but they are plausible. Design/methodology/approach; The authors demonstrate why researchers, clinicians, policymakers and other public health stakeholders should be vigilant to the potential increases in murder-suicide in the wake of the COVID-19 pandemic. Findings; During the COVID-19 pandemic, there have been reports of increased gun sales, alcohol sales, intimate partner violence and child neglect/abuse. These factors give one serious pause regarding the potential for murder-suicide, especially in the context of other pandemic-related stressors (e.g. loneliness, economic stress, health anxiety). Originality/value: This paper highlights pandemic-related factors that might spur increased murder-suicide and encourages murder-suicide prevention efforts to take place alongside other pandemic-related public health interventions.
Khan, A.R., et al. (2020). Men, suicide, and Covid-19: Critical masculinity analyses and intervention. Postdigital Science and Education. https://doi.org/10.1007/s42438-020-00152-1
A commentary on the role socialization plays in the high rates of male suicide and how the COVID-19 pandemic may provide opportunity its prevention and intervention.
Suicide is a global public health burden, causing around 800,000 deaths annually along with many more attempts (World Health Organization 2019). Since Émile Durkheim’s classic study Le Suicide (Durkheim 1951), it has been repeatedly confirmed that suicide rates spike up during and after crises (Chang, Stuckler, Yip, and Gunnell 2013; Iemmi et al. 2016; Gunnell et al. 2020). Recent research reports indicate that various socioeconomic, psychological, and health-related impacts of the Covid-19 pandemic may heighten the risk of suicidal behaviors (Reger, Stanley, and Joiner 2020; Gunnell et al. 2020). Uncertainties caused by the Covid-19 pandemic, coupled with global responses such as lockdowns, have heightened depression, anxiety, isolation, loneliness, financial concerns, anger, irritability, relationship conflicts, post-traumatic stress disorder, fears, and increased use of alcohol and tobacco (Tull et al. 2020; Courtet, Olié, Debien, and Vaiva 2020). Factors like these intensify risk from suicidal behaviors in people who are traditionally considered as vulnerable and in people who were not considered at risk prior to the pandemic (Suicide Awareness Voices of Education 2020; Courtet et al. 2020). Men demonstrate higher suicide rates than women at all times and across regions and ethnic and socioeconomic groups (Vijayakumar 2015; Naghavi 2019; Cleary 2019), and current sources indicate similar trends during the Covid-19 pandemic (Mooney, Kaplan, and Denis 2020). A recent online international newspaper review attributes 15 suicide cases, 2 suicide attempts, and 1 homicide-suicide to the concomitant impact of Covid-19. All victims except one were men, from all tiers of society (Khan, Arendse, and Ratele 2020). Another international review reports 7 suicide cases associated with the Covid-19 pandemic, 5 of which were men (Thakur and Jain 2020). A country-specific review in Pakistan identifies 12 suicide cases and 4 suicide attempts related to Covid-19; 12 comprised men who suffered serious economic hardships during the pandemic (Mamun and Ullah 2020). Another country-specific review in Bangladesh captures 9 suicide cases associated with Covid-19, 5 of which were men who encountered financial constraints induced by the pandemic (Bhuiyan, Sakib, Pakpour, Griffiths, and Mamun 2020). This preliminary data is still far from complete, and newspaper stories are often ridden with exaggerations and sensationalism. However, positive correlation between longitudinal studies and recent reports indicates that male suicide during the Covid-19 pandemic requires dedicated attention.
Sumner, S.A., et al. (2020). Adherence to suicide reporting guidelines by news shared on a social networking platform. Proceedings of the National Academy of Sciences of the United States of America. 202001230; DOI: 10.1073/pnas.2001230117
Safe media reporting of suicide is considered a best practice in suicide prevention and adherence to it is the impetus for this study. The authors examine a sample of news articles pertaining to suicide and their fidelity to suicide reporting guidelines and the impact it has on subsequent sharing on Facebook.
Rates of suicide in the United States are at a more than 20-y high. Suicide contagion, or spread of suicide-related thoughts and behaviors through exposure to sensationalized and harmful content is a well-recognized phenomenon. Health authorities have published guidelines for news media reporting on suicide to help prevent contagion; however, uptake of recommendations remains limited. A key barrier to widespread voluntary uptake of suicide reporting guidelines is that more sensational content is perceived to be more engaging to readers and thus enhances publisher visibility and engagement; however, no empirical information exists on the actual influence of adherence to safe-reporting practices on reader engagement. Hence, we conducted a study to analyze adherence to suicide-reporting guidelines on news shared on social media and to assess how adherence affects reader engagement. Our analysis of Facebook data revealed that harmful elements were prevalent in news articles about suicide shared on social media while the presence of protective elements was generally rare. Contrary to popular perception, closer adherence to safe-reporting practices was associated with a greater likelihood of an article being reshared (adjusted odds ratio [AOR] = 1.19, 95% confidence interval [CI] = 1.10 to 1.27) and receiving positive engagement (“love” reactions) (AOR = 1.20, 95% CI = 1.13 to 1.26). Mean safe-reporting scores were lower in the US than other English-speaking nations and variation existed by publisher characteristics. Our results provide empirical evidence that improved adherence to suicide-reporting guidelines may benefit not only the health of individuals, but also support publisher goals of reach and engagement.
🇨🇦 Ranahan, P. (2020). Suicide prevention education within youth work higher education: Negotiating presence and procedure. International Journal of Child, Youth and Family Studies. 11(3): 167–191 DOI: 10.18357/ijcyfs113202019714
A Canadian study of mental health education for youth work, including a suicide intervention element, in a university context.
Child and youth care practitioners are likely to encounter issues of suicidality. Practitioners play an important role in the well-being of youth; thus, mental health literacy, and suicide prevention education in particular, should be an integral part of child and youth care pedagogy and curricular practices in higher education programs. With the aim of explicating a social process of learning and applying mental health literacy, this grounded theory study examined how a curriculum specifically designed for child and youth care practitioners is subsequently applied in suicide or mental health interventions. Thirteen students enrolled in youth work courses at a large university in Eastern Canada participated in the 18-month study in 2015 and 2016. Informed by critical and social literacy theories, conceptualizations of mental health literacy, and experiential pedagogy within higher education, analysis of the data identified a process of becoming and being in youth work comprising two subcategories: struggling to become a youth worker, and being a youth worker. Conditions, such as particular pedagogical strategies and specific content, served to shape and influence the process and, consequently, participants’ movement therein. The inclusion of a suicide intervention learning activity was a condition that influenced participants’ learning processes, yet also reflected a struggle with the dialectical position of presence and procedure. Recommendations and insights are discussed with the aim of enhancing pedagogical approaches to suicide intervention within child and youth care higher education programs.
Iob, E., et al. (2020). Abuse, self-harm and suicidal ideation in the UK during the COVID-19 pandemic. The British Journal of Psychiatry. doi: 10.1192/bjp.2020.130
An online questionnaire conducted in the UK between March and April 2020 is used to identify the prevalence of abuse, self harm, and suicidal ideation during the COVID-19 pandemic.
This study explored patterns of abuse, self-harm and thoughts of suicide/self-harm in the UK during the first month of the COVID-19 pandemic using data from the COVID-19 Social Study (n=44 775), a non-probability sample weighted to population proportions. The reported frequency of abuse, self-harm and thoughts of suicide/self-harm was higher among women, Black, Asian and minority ethnic (BAME) groups and people experiencing socioeconomic disadvantage, unemployment, disability, chronic physical illnesses, mental disorders and COVID-19 diagnosis. Psychiatric medications were the most common type of support being used, but fewer than half of those affected were accessing formal or informal support.
Shannon, M. (2020). Physical activity, sedentary and dietary behaviors associated with indicators of mental health and suicide risk. Preventive Medicine Reports. Retrieved from https://www.sciencedirect.com/science/article/pii/S2211335520301133
Data from the American 2017 national Youth Risk Behavior Survey (YRBS) are used to identify relationships between physical activity, sedentary and dietary behaviors,and mental health factors, including suicide risk.
Abstract: We used data from the 2017 national Youth Risk Behavior Survey to examine associations between physical activity, sedentary, and healthy dietary behaviors and indicators of mental health, suicidal thoughts, and suicidal attempts among a representative sample of US high school students. Sex-stratified logistic regression was used to separately model each mental health-related outcome on the health-related behaviors, while controlling for race/ethnicity, grade, and body weight status. Significant associations were found between insufficient physical activity, sedentary, and less healthy dietary behaviors and the mental health-related outcomes. Feeling sad and hopeless was associated with not eating breakfast on all 7 days (past week), drinking soda or pop (female only), not meeting the aerobic physical activity guideline (male only), not playing on at least one sports team, and playing video/computer games or using a computer more than two hours (per day). Suicidal thoughts were associated with not eating breakfast on all 7 days, drinking soda or pop, not meeting the aerobic physical activity guideline, and playing video/computer games or using a computer more than two hours. Attempted suicide was associated with not eating breakfast on all 7 days, drinking soda or pop, drinking sports drinks, watching television more than two hours, and playing video or computer games or using a computer more than two hours (male only). While limiting sedentary behaviors and increasing physical activity and healthy dietary behaviors is not a sole solution for improving mental health among adolescents, it could be another possible strategy used in schools to benefit all students.
John, A. (2020). The impact of the COVID-19 pandemic on self-harm and suicidal behavior: Protocol for a living systematic review. F1000 Research. DOI: https://doi.org/10.12688/f1000research.24274.1
A protocol of a living systematic review of research involving the effects of the COVID-19 pandemic on self-harm and suicidal behaviours.
Abstract- Background: The COVID-19 pandemic has caused widespread morbidity and mortality as well as disruption to people’s lives and livelihoods around the world; this has occurred as a result of both infection with the virus itself and the health protection measures taken to curb its spread. There are
concerns that rates of suicide, suicidal behaviours and self-harm may rise during and in the aftermath of the pandemic. Given the likely rapidly expanding research evidence base on the pandemic’s impact on rates of suicide, suicidal behaviours and self-harm and emerging evidence about how best to mitigate such effects, it is important that the best available knowledge is made readily available to policymakers, public health specialists and clinicians as soon as is possible. To facilitate this, we plan to undertake a living systematic review focusing on suicide prevention in relation to COVID-19. Method: Regular automated searches will feed into a web-based screening system which will also host the data extraction form for included articles. Our eligibility criteria are wide and include aspects of incidence and prevalence of suicidal behaviour, effects of exposures and effects of interventions in relation to the COVID-19 pandemic, with minimal restrictions on the types of study design to be included. The outcomes assessed will be death by suicide; self-harm or attempted suicide (including hospital attendance and/or admission for these reasons); and suicidal thoughts/ideation. There will be no restriction on study type, except for single case reports. There will be no restriction on language of publication. The review will be updated at three-monthly intervals if a sufficient volume of new evidence justifies doing so. Conclusions: Our living review will provide a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide.
🇨🇦 Richardson, E. (2020). The suicide clause. Canadian Military History, 29(1). Retrieved from https://scholars.wlu.ca/cgi/viewcontent.cgi?article=2014&context=cmh
Historical account of how suicide was handled in the Canadian military, particularly during the second world war. There is much historical information of suicide in a Canadian legal context as well.
Abstract – This article explores the ways in which Canadian military authorities responded to suicide during the Second World War. Attestation papers represented an agreement between Canadians and the state. They would serve, but in return, Canada owed them certain considerations should they die during their service. Servicemen suicide, then, raised questions about Canada’s obligations to its servicemen. Divided by the requirements of the law and compassion for families, military authorities struggled to find the appropriate way to handle suicide. This paper argues that convention treated suicide as insufficient grounds upon which to break the covenant between serviceman and state.
Deady, M., et al. (2020). Unemployment, suicide, and COVID-19: Using the evidence to plan for prevention. The Medical Journal of Australia. Retrieved from https://www.mja.com.au/system/files/2020-06/Deady%20mja20.00600%20-%2022%20June%202020.pdf
An Australian rapid review of the literature focusing on the relationship between unemployment and suicide as a result of the lockdown measures imposed during the COVID-19 pandemic.
Abstract – In response to the COVID-19 pandemic, restrictions on movement and business operations have resulted in a sharp rise in unemployment. Global data consistently show that during times of economic hardship and rising unemployment, rates of suicide frequently rise. Certain measures have been found to be important in mitigating this increase. We present recommendations to lessen the potential impact of this crisis on suicide rates in Australia and ensure those who are affected are well-supported. These recommendations include aspects of welfare support, labour market programs, treatment, and prevention interventions, and coordinated care and reporting.
Leung, T., et al. (2020). Physician suicide: A scoping literature review to highlight opportunities for prevention. Global Psychiatry, 3(2). Retrieved from https://content.sciendo.com/view/journals/gp/ahead-of-print/article-10.2478-gp-2020-0014/article-10.2478-gp-2020-0014.xml
A comprehensive examination of the extant literature pertaining to physician suicide.
Abstract – Objective: The aim of this scoping review is to map the current landscape of published research and perspectives on physician suicide. Findings could serve as a roadmap for further investigations and potentially inform efforts to prevent physician suicide. Methods: Ovid MEDLINE, PsycINFO, and Scopus were searched for English-language publications from August 21, 2017 through April 28, 2018. Inclusion criteria were a primary outcome or thesis focused on suicide (including suicide completion, attempts, and thoughts or ideation) among medical students, postgraduate trainees, or attending physicians. Opinion articles were included. Studies that were non-English or those that only mentioned physician burnout, mental health, or substance use disorders were excluded. Data extraction was performed by two authors. Results: The search yielded 1,596 articles, of which 347 articles passed to the full-text review round. The oldest article was an editorial from 1903; 210 (60.3%) articles have been published from 2000 to present. Authors originated from 37 countries, and 143 (41.2%) were opinion articles. The most discussed were suicide risk factors and culture of practice issues, while the least discussed themes included public health and postvention. Conclusions: Consistency and reliability of data and information about physician suicides could be improved. Data limitations partly contribute to these issues. Also, various suicide risk factors for physicians have been explored, and several remain poorly understood. Based on this scoping review, a public health approach, including surveillance and early warning systems, investigations of sentinel cases, and postvention may be impactful next steps in preventing physician deaths by suicide.
This is a summary of the latest significant Canadian (🇨🇦) and international suicide research we collected in the past month:
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Thank you to the Calgary Foundation for generously supporting our Strategic Systems Integration project with their Community Grant; we acknowledge the Calgary Foundation’s Education & Lifelong Learning Advisory Committee for their ongoing support of suicide prevention!