Research Roundup – July 2022
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month:
Mental Health Commission of Canada. (2022). Mental health and suicide prevention in men [Evidence brief]. mentalhealthcommision.ca
This is a brief by the Mental Health Commission of Canada presenting an overview of emerging research on men’s mental health with a particular focus on suicide and its prevention in Canada.
Abstract – Of the estimated 4,000 suicide deaths in Canada each year, 75 per cent are men. Suicide is the country’s second leading cause of death for men aged 15-39 (after accidental death). Research into sex differences in suicidal behaviour has revealed a gender paradox, wherein men are more likely to die by suicide, and women are more like to attempt it. Between 1981 and 2017, men consistently had higher mortality rates due to suicide compared to women. During this time, the average “male-to-female ratio” of suicide deaths was 3.4:1, meaning that men died by suicide on average 3.4 times as often as women. These disproportionately high rates have not only been observed across time, but also across the lifespan, where men’s rates of suicide are consistently higher than women at all ages.
Mishara, B. & Weisstub, D. (2022). From involuntary incarceration to Medically Assisted Suicide: Mental illness, suicide and autonomous judgement. Ethics, Medicine and Public Health, 23, 100779. DOI: 10.1016/j.jemep.2022.100779
The authors examine the practices of involuntary commitment of the mentally ill and forced treatment of suicidal persons, as well as the concept of personal autonomy which often underpins Medically Assisted Death (MAD).
Abstract – Background: Involuntary commitment of the mentally ill and forced treatment of suicidal persons are practiced worldwide, with underlying premises that contrast with the respect for autonomy upon which Medically Assisted Death (MAD) (euthanasia and assisted suicide) for the mentally ill is based. Methodology: We trace the transition from paternalistic mass incarcerations to hospitalization only for dangerousness. Results: In response to criticisms that predicting dangerousness is indefensibly inexact, criteria have shifted to emphasize incompetence. Outside the judicial and legislative realms, helplines use different ethical premises operationalized in contrasting practices in response to persons who have attempted or are at imminent risk of attempting suicide. Some respect refusals of help while others organize invasive rescues. In carceral institutions with inhumane conditions, controversial forced feeding protocols pit the desire to save lives against forced living with extreme suffering. As MAD for persons suffering from a mental disorder is increasingly debated, arguments in favor focus on recognition of the capacity for self-determination, the benevolence of ending interminable suffering, and MAD as a human right which the mentally ill should be able to access without discrimination. Opponents cite research on the unpredictable course of mental disorders and inability to predict when the disorder is irremediable. They emphasize pervasive ambivalence in suicidal desires and that legalizing MAD for mental illness is inherently stigmatizing.
Sjoblom, E., Ghidei, W., Leslie, M., James, A., Bartel, R., Campbell, S., & Montesanti, S. (2022). Centering Indigenous knowledge in suicide prevention: A critical scoping review. Research Square. DOI: 10.21203/rs.3.rs-1713950/v1
This is a review of 56 academic studies and 16 articles from the grey literature which study Indigenous-centred approaches to suicide prevention.
Abstract – Background: Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention—typically involving individual-level efforts for behavioural change via mental health professional intervention—by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations. Methods: A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings. Results: Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous self-determination; and (4) employing decolonial approaches. Conclusions: Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities.
O’ Riordan, M., Ma, J., Mazzer, K., Batterham, P., Kõlves, K., Woodward, A., Klein, B., Larsen, M., Goecke, R., Gould, M. & Rickwood, D. (2022). Help-seeker expectations and outcomes of a crisis support service: Comparison of suicide-related and non-suicide-related contacts to lifeline Australia. Health and Social Care. DOI: 10.1111/hsc.13857
A study of help-seekers who had previously contacted Lifeline Australia by telephone, online chat, or text message. The researchers sought to compare those whose contacts were suicide-related and those that were non-suicide related.
Abstract – Lifeline Australia aims to prevent suicide and support community members in personal crisis via the provision of free anonymous telephone, online chat and text message services. This study aimed to identify the expectations and outcomes of Lifeline help-seekers, including whether there are differences between suicide-related and non-suicide-related contacts. Help-seekers (N = 553) who had previously contacted Lifeline via telephone, online chat, or text message crisis services were recruited via social media and a link provided after Lifeline service use, who completed an online survey about their awareness, expectations and outcomes of Lifeline’s services. The responses from help-seekers who self-reported suicide-related and non-suicide-related reasons for contact were compared. Participants were highly aware of Lifeline’s services, particularly the phone service. The main expectations of all help-seekers were to feel heard and listened to, feel less upset and feel understood. There were 59.5% of the sample that reported suicidality as a reason for contact. Suicide-related contacts endorsed more reasons for contact than non-suicide-related contacts. Expectations of suicide-related help-seekers were greater, but they were less likely to report that their expectations were met. The high expectations and complexity of suicide-related contacts reveal the challenges in meeting the needs of this high-priority group, particularly within the context of the multiple demands on crisis support services.
Jacobsen, A., Madsen, T., Ranning, A., Storgaard Nielsen, A., Nordentoft, M. & Erlangsen, A. (2022). Level of suicidal ideation among callers to the Danish suicide prevention helpline. Archives of Suicide Research. DOI: 10.1080/13811118.2022.2084005
Calls to the Danish suicide prevention helpline from 2018-2019 were analyzed for risk of suicide, shared characteristics for those at risk, and for level of suicidal ideation.
Abstract – Objective: The aim of this study was to: (1) determine the proportion of callers to a national helpline for suicide prevention who were evaluated to be at risk of suicide; (2) identify characteristics associated with being at risk; (3) determine the level of suicidal ideation among callers, as measured by a clinical scale, and compared to the general population. Method: Data on all calls answered at the Danish helpline for suicide prevention during 2018–2019 were analyzed. These consisted of socio-demographic covariates and items related to suicidality, including the Suicidal Ideation Attribute Scale (SIDAS). Data on SIDAS for the general population derived from a survey. Being at risk of suicide, as evaluated by the counselors, was examined as outcome in adjusted logistic regressions. Results: Among 42,393 answered calls, 24,933 (59%) related to personal concerns. Of these, 47% and 14% of callers, respectively, had suicidal thoughts and concrete suicidal plans, while 53% were evaluated to be at risk. Higher risks were found when issues related to self-harm, mental health problems, eating disorders, incest, physical health problems, substance abuse, or sexual assault were mentioned. In all 37% of callers who were administered the SIDAS scale were evaluated to be at high risk of suicide compared to 1.5% in the general population. Conclusions: A substantial share of callers to a national helpline for suicide prevention were evaluated to be at risk of suicide, also when using a clinical scale. This emphasizes the potential for counselors to prevent suicidal behavior.
Nason, E., Blankenship A., Benevides, E. & Stump, K. (2022). The role of social work in confronting the farmer suicide crisis: Best practice recommendations. Social Work in Public Health. DOI: 10.1080/19371918.2022.2093305
This is an examination of suicidality in both the farming industry and rural areas and how social workers can best serve the mental health needs of these communities.
Abstract – Although estimates of prevalence vary, suicide rates among farmers are high and pose an important challenge for mental health policy and practice. The lack of mental health resources in many rural communities is a significant barrier to improving farmer mental health outcomes. The current paper will review (1) current findings related to the psychosocial functioning of agriculturalists including rates of suicide and common mental health concerns within this population; (2) describe stressors and risk factors associated with mental health symptoms in rural and agricultural communities; and (3) discuss barriers associated with accessing mental health treatment. This article also includes recommendations for increasing the cultural competence of social work practitioners working with rural communities. Finally, existing research on using technology and workforce development approaches for increasing access to mental health in rural communities is presented and recommendations for future research are explored.
Mete, R. (2022). Examination of the geographic parameters of suicide: A comparison study of Ontario and Alberta. International Journal of Psychiatry Research, 5(3), 1-12.
Suicide rates vary by province in Canada. This study looks at the differences in rates of suicide between the provinces of Alberta and Ontario in the years 2007-2012 and what factors may drive these differences.
Abstract – This paper looks at the following research questions: Historically, what are the provincial rates of suicidal thoughts among the citizens of Ontario and Alberta? These rates will be compared from 2007 to more recent data from 2012. What are the rates of suicide within the provinces of Ontario and Alberta from 2007 to 2012? Where are the locations of emergency departments within Ontario and Alberta and per what population ratio?
Westerlund, M. & Nilsson, H. (2022). Suicide communication on digital platforms: A research review. Swedish Media Council.
A Swedish government report by the Swedish Media Council on research into suicidal communications in the digital environment. This, along with other assignments, will inform a forthcoming national strategy for mental health and suicide prevention.
Abstract – In the autumn of 2020, the Swedish government assigned the Swedish Media Council, together with 24 other authorities, to provide a basis for an upcoming national strategy for mental health and suicide prevention. The present research overview has been produced by the Swedish Media Council as a contribution to the ongoing work. The government assignment is led by the Public Health Agency of Sweden and the National Board of Health and Welfare, and the final report to the Ministry of Social Affairs will take place on 1 September 2023. The Swedish Media Council is a government agency whose primary task is to promote the empowering of minors as conscious media users and to protect them from harmful media influences. There are no specific assignments on mental health or suicide prevention in the agency’s instruction, but there are nevertheless links between the agency’s task and mental health.
Fortune, S. & Hetrick, S. (2022). Suicide risk assessments: Why are we still relying on these a decade after the evidence showed they perform poorly? Australian & New Zealand Journal of Psychiatry. DOI: 10.1177/00048674221107316
A commentary on the relevancy and efficacy of suicide risk assessments.
Abstract – Suicide deaths have a profound impact on whānau and community and are a tragic loss. However, from a statistical point of view, suicide is a relatively rare event. Predicting rare events is difficult, and the implications for suicide prevention were highlighted in an important editorial in this journal more than a decade ago, yet little seems to have changed. Risk assessment that focuses on accurate prediction of suicide in real-world contexts is given a great deal of attention in mental health services, despite the fact that current scientific knowledge and best practice guidelines in this area highlight that it is unlikely to be a good basis on which to provide access to treatment. It is our view that we have a good enough understanding of the common conditions people who struggle with suicidal distress experience and energy is better directed at acting to reduce exposure to these conditions and providing treatment for those who seek it. Blueprints for successful suicide prevention exist. If we lessen the focus on prediction, we will have greater resources to focus on treatment and prevention.
Meurk, C., Roberts S., Lam, M., Wittenhagen, L., Callaway, L., Moss, K., Lucke, J., Barker, R., Waterson, E., Rawlinson, C., Malmstrom, N., Weaver, E., Hoehn, E., Bosley, E., Watson, S. & Heffernan E. (2022). Suicide crises among women and mothers during and around the time of pregnancy: Prevalence and timing of initial contact with first responders and health services. Australian and New Zealand Journal of Psychiatry. DOI: 10.1177/00048674221101517
This is an Australia study of suicidal behaviours and crises experienced by women and mothers during pregnancy and 2 years postpartum. Data were culled from 3020 cases in the Partners in Prevention (PiP) study of Queensland, Australia.
Abstract – Objectives: Suicide is a leading cause of maternal mortality. Suicidality during and around the time of pregnancy can have detrimental impacts on a child’s development and outcomes. This paper examines prevalence, demographic characteristics, and timing of initial contact with first responders and health services for a cohort of women who experienced suicidality during and around the time of pregnancy. Methods: Findings are drawn from the Partners in Prevention (PiP) study, a population-wide linked data set of suicide-related attendances by police or paramedics in Queensland, Australia. A sub-cohort of women was identified, who were between 6 months preconception and 2 years postpartum at the time of a suicide-related contact with police or paramedics (PiP-Maternal). Findings are compared to other girls and women who had a suicide-related contact with police or paramedics (PiP-Female). Prevalence, demographic characteristics, timing of contact with first responders and health services, re-presentations, and mortality are reported. Results: The PiP-Maternal cohort comprised 3020 individuals and 3400 births. Women in the PiP-Maternal cohort were younger, more likely to be of Aboriginal and/or Torres Strait Islander descent and live outside of a major city than the PiP-Female cohort. There were high rates of out-of-hours calls to police and ambulance, and similar perceived seriousness of the call between women in the PiP-Maternal and PiP-Female cohorts. Women in the PiP-Maternal cohort were less likely to be admitted to an emergency department within 24 hours, even after matching on covariates. Prevalence of suicidality for women who were pregnant and up to 2 years postpartum was 1.32% (95% CI = [1.27, 1.37]). Conclusion: Vulnerabilities and high rates of contact with police or paramedics, coupled with lower levels of follow-up, highlight the critical need to improve service responses for women with mental health needs during these phases of life.
Aluri, J., Lewis, S., Torres, M. & Wilcox, H. (2021). A suicide prevention initiative across a multi-campus university before and during the COVID-19 pandemic. Journal of American College Health. DOI: 10.1080/07448481.2022.2076563
A report on a suicide prevention project – John Hopkins Suicide Prevention Awareness, Response and Co-ordination (JH-SPARC). One of the programs of the project, suicide screening, involved an invitation to students at Johns Hopkins to participate in stress and depression screening. The results are highlighted.
Abstract – Increasing rates of depression, anxiety, substance use, and suicidal thoughts and behaviors among college students were exacerbated by the COVID-19 pandemic. This report describes how components of the Johns Hopkins Suicide Prevention Awareness, Response and Coordination (JH-SPARC) Project aligned with a multi-faceted strategy for suicide prevention. Key programs included suicide screening, gatekeeper trainings, and the use of third-party mental health services. Regarding suicide screening outcomes, staff sent 36,148 individual emails inviting students and trainees to participate in stress and depression screening. This approach garnered 2,634 responses and connected 130 students to care, 66 of whom (50.8%) indicated suicidal thoughts, plans, or behaviors. We estimate this screening cost $2.97 per student. Important lessons included the reliance on virtual platforms and the need to coordinate efforts across multiple campuses. Our manuscript provides an example of a transferable strategy for suicide prevention on college campuses in the pandemic era.
Liu, H., Huang, Y., Tjung, J., Sun F. & Liu, S. (2022). Recent exposure to others’ confided suicidal thoughts and risk of self‑harm and suicidality among adolescents. Current Psychology. DOI: 10.1007/s12144-022-03123-w
This is a study of Taiwanese high school students measuring exposure to confided suicidal thoughts and its effects on self-harm or suicidal behaviours.
Abstract – Few studies have investigated the contagion effects of exposure to others’ confided suicidal thoughts among adolescents. The aim of this study was to investigate whether recent real-world exposure to confided suicidal thoughts was associated with adolescent self-harm and suicidality within one month, and if so, to determine the related risk and protective factors. A total of 5,879 Taiwanese first-year senior high school students participated in this study and completed on-line questionnaires regarding their experience of exposure to confided suicidal thoughts, self-harm and suicidality, socio-demographic information, Patient Health Questionnaire 9-item, Multi-Dimensional Support Scale, Rosenberg Self-Esteem Scale, and alcohol and cigarette use. Of the enrolled adolescents, 3.4% had been exposed to confided suicidal thoughts (N = 200) within one month. The most common source of exposure was friends (N = 186). After controlling for a large variety of confounders, the adolescents with recent exposure to others’ suicidal thoughts were four times more likely to harm themselves within one month (OR = 3.77; 95% CI: 2.26 – 6.30). The risks of suicidal ideation and suicide plans were also markedly increased (both OR = 5.15; 95% CI: 3.48 – 7.64 and 2.78 – 9.52, respectively). The risk ratios were highest if the source of exposure was from parents, and the contagion effects were dose-dependent. Support from parents and teachers could protect the adolescents from the impact of contagion. Our results suggest a contagion effect of exposure to confided suicidal thoughts among adolescents. Parents and school personnel should be aware of this and provide assistance for those in need. Practical and Social Implications: This work provides potential ways to improve current prevention and postvention practices for both the suicide-bereaved and those struggling with suicidality.