Research Roundup – June 2020
This is a summary of the latest significant Canadian (🇨🇦) and international suicide research we collected in the past month:
Kennedy, A., Brumby, S., Versace, V. & Brumby-Rendell, T. (2020). The ripple effect: A digital intervention to reduce suicide stigma among farming men. BMC Public Health. DOI:https://doi.org/10.1186/s12889-020-08954-5
Farmers are considered at an-risk occupational group for suicide. This Australian study looks at a digital intervention – The Ripple Effect – and its capacity to address suicide literacy and stigma among farmers.
Abstract – Background: Compared with the general population, Australian farmers—particularly men—have been identified as at greater risk of suicide. A complex range of factors are thought to contribute to this risk, including the experience of Stigma. stigma also impacts those who have attempted suicide, their carers, and those bereaved by suicide—manifesting as shame, guilt, social isolation, concealment of death, reduced help seeking and ongoing risk of suicide. This paper evaluates the effectiveness of an intervention, tailored for the farming context, designed to reduce stigma among farming men with a lived experience of suicide. Results: The intervention was successful in reaching members of the target group from across Australia’s rural communities—with diverse geographic locations and farming industries represented. One hundred and sixty-nine participants from the target group (farming males aged 30–64 years) were recruited. While the Stigma of Suicide Scale failed to identify a reduction in self- or perceived-stigma, qualitative data and participant feedback identified behavioural indicators of stigma reduction. Four subthemes—‘growth’, ‘new realisations’, ‘hope’ and ‘encouragement’—highlighted attitudinal and behaviour change indicative of reduced stigma associated with mental health and suicide. Participants’ baseline suicide literacy (Literacy of Suicide Scale) was high when compared with previous community samples and total literacy scores did not demonstrate significant improvement over time, although literacy about the link between suicide and alcoholism did significantly improve. Conclusions: These results highlight opportunities in groups with high suicide literacy for targeted stigma reduction and suicide prevention efforts for both the target group and other populations within Australia and internationally. Results also highlight the need to reassess how stigma change is understood and evaluated across a wider range of population groups.
Riblet, et al. (2020). A pandemic of body, mind, and spirit: The burden of “social distancing” in rural communities during an era of heightened suicide risk. The Journal of Rural Health. DOI: 10.1111/jrh.12456
American statistics in recent years show that there is a growing number of suicides in rural United States. The public health measures implemented during COVID-19 may exacerbate the lack of mental health access and social isolation already pronounced in rural areas.
Abstract – Death by suicide is a serious problem in the United States and rural communities are disproportionally affected by these tragedies.1 According to the National Vital Statistics System (NVSS), suicide rates in rural communities have risen significantly over the past few decades.1 The gap between the suicide rates in rural and urban communities is broadening and suicide rates are increasing at a faster rate in rural communities than they are in urban communities.1 For example, between 2010 and 2015, the suicide rates per 100,000 population in nonmetropolitan/rural counties increased by 7.1% compared to 1.6% in urban counties.1 These findings may be explained by factors such as decreased access to mental health resources, stigma, and economic stressors.2 Importantly, social isolation is an ongoing concern in rural areas, worsens mental health, and is a factor in suicide risk.2 Accordingly, there is an increased emphasis on the need to build social supports or connectedness among communities as a strategy to combat suicide.
Ferlatte, O., et al. (2020). Depression and suicide literacy among Canadian sexual and gender minorities. Archives of Suicide Research. https://doi.org/10.1080/13811118.2020.1769783
A high level of depression and suicide literacy has been found to indicate better help-seeking attitudes. This study looks at the depression and suicide literacy levels of several different sexual and gender minority populations and comparisons to one another and cisgender equivalents.
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.
Szlyk, H., et al. (2020). Coronavirus disease 2019 takes adolescent suicide prevention to less charted territory. Journal of Adolescent Health.
The authors view the medium of telehealth as an opportunity to overcome the current barriers of the COVID-19 pandemic in meeting the mental health needs for adolescents.
Abstract – The last decade saw an increase in national attention to suicide as the second leading cause of death among adolescents [1] and for increased youth suicide prevention efforts. Adolescents at highest risk are typically referred to emergency departments for assessment and immediate safety management, and those who cannot be maintained safely at home are often hospitalized on inpatient psychiatric units until risk decreases. At the outpatient level, mental health interventions include individual and group psychotherapy, family and collateral sessions, and medication management. However, the implementation of social distancing for minimizing the spread of coronavirus disease 2019 (COVID-19) has limited the availability of traditional “in-person” interventions to treat adolescents at risk for suicide. How do we best address the mental health needs of suicidal adolescents during the largest public health crisis of our lifetimes? This question presents an unprecedented challenge for mental health providers, researchers, and families.
🇨🇦 Flett & Heisel. (2020). Aging and feeling valued versus expendable during the COVID-19 pandemic and beyond: A Review and commentary of why mattering is fundamental to the health and well-being of older adults. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-020-00339-4
This Canadian paper looks at the psychological concept of “mattering” and a review of its research that pertains to the mental health and overall well-being of older adults.
Abstract – The current commentary and review examines the potentially protective role of feelings of mattering among elderly people during typical times and the current atypical times associated with the COVID-19 global pandemic. Mattering is the feeling of being important to others in ways that give people the sense that they are valued and other people care about them. We contrast this feeling with messages of not mattering and being expendable and disposable due to ageism, gaps in the provision of care, and apparently economically focused positions taken during the pandemic that disrespect the value, worth, and merits of older persons.We provide a comprehensive review of past research on individual differences in mattering among older adults and illustrate the unique role of mattering in potentially protecting older adults from mental health problems. Mattering is also discussed in terms of its links with loneliness and physical health. This article concludes with a discussion of initiatives and interventions that can be modified and enhanced to instill a sense of mattering among older adults. Key directions for future research are also highlighted along with ways to expand the mattering concept to more fully understand and appreciate the relevance of mattering among older adults.
Hochhauser, S., et al. (2020). Why social justice matters: A context for suicide prevention efforts. International Journal for Equity in Health. 19:76 https://doi.org/10.1186/s12939-020-01173-9
A paper proposing a model to address suicide and suicide prevention through a socio-economic lens, allowing for improvement to those historically and systemically marginalized from mental health supports.
Abstract – Suicide is among the 10 leading causes of death in the US and has the potential to suddenly change many lives. It often occurs when people are disproportionately affected by societal conditions, including inequities, discrimination, oppression, and historical trauma. We posit that a social justice framework can improve suicide prevention efforts when incorporated into existing strategies because it mandates that inequities be addressed. It does so through education, engagement, advocacy, and action, and can be especially effective in states and nations with high suicide rates and entrenched societal inequities.
Czyz, E.K., et al. (2020). Augmenting safety planning with text messaging support for adolescents at elevated suicide risk: Development and acceptability study. JMIR Publications. doi: 10.2196/17345.
A study of follow-up care for adolescents at risk for suicide, evaluating the utility of text-messaging supports as a key component of safety planning.
Abstract – Background: Suicide is the second leading cause of death among adolescents. A critical need exists for developing promising interventions for adolescents after psychiatric hospitalization who are at a high risk of experiencing repeated suicidal behaviors and related crises. The high-risk period following psychiatric hospitalization calls for cost-effective and scalable continuity of care approaches to support adolescents’ transition from inpatient care. Text messages have been used to improve a wide range of behavioral and health outcomes and may hold promise as an accessible continuity of care strategy for youth at risk of suicide. Results: Quantitative and qualitative feedback across the 2 study phases pointed to the acceptability of text-based support. Messages were seen as having the potential to be helpful with the transition after hospitalization, with adolescents indicating that texts may serve as reminders to use coping strategies, contribute to improvement in mood, and provide them with a sense of encouragement and hope. At the same time, some adolescents expressed concerns that messages may be insufficient for all teens or circumstances. In phase 2, the passage of time did not influence adolescents’ perception of messages in the month after discharge (P=.74); however, there were notable daily level associations between the perception of messages and adolescents’ affect. Specifically, higher within-person (relative to adolescents’ own average) anger was negatively related to liking text messages (P=.005), whereas within-person positive affect was associated with the perception of messages as more helpful (P=.04). Conclusions: Text-based support appears to be an acceptable continuity of care strategy to support adolescents’ transition after hospitalization. The implications of study findings are discussed. Future work is needed to evaluate the impact of text-based interventions on suicide-related outcomes.
🇨🇦 Sinyor, M., et al. (2020). Changes in suicide and resilience-related Google searches during the early stages of the COVID-19 pandemic. The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie. 1-3. doi.org/10.1177/0706743720933426
A Canadian analysis of internet search data relating to mental health, both help-seeking and suicide-related, captured during the initial phase of COVID-19. These “proxy indicators” may help inform “an early public health response.”
Abstract – Pandemics such as the 2019 coronavirus (COVID-19) outbreak have the potential to negatively impact mental health, which may, in turn, influence suicide rates.2 Due to the substantial lag before mortality data become available, it will be some time before that can be investigated. More readily available proxy indicators, such as Google search trends, may be of value both for early characterization of the impact of COVID-19 on suicide and in formulating an early public health response. However, this has never been tested in the context of a pandemic. We aimed to characterize changes in suicide-related searches worldwide and in the United States (the country with the most reported COVID-19 cases to date) to identify potential early indications of impact on suicide which can later be compared to mortality data.
Shirley, K.A. (2020). Reported Trends in Suicidality in Children 10 and Younger. Journal of Mental Health Counseling. Volume 42/Number 1/January 2020/Pages 47–62/https://doi.org/10.17744/mehc.42.1.04
One of the most under-reported and under-researched populations for suicide is the 12 years and under demographic–children. This report attempts to remedy this gap by offering some very robust data.
Abstract – As reported by the Centers for Disease Control and Prevention in 2015, a child aged 5 to 14 years dies by suicide nearly once per day in the United States. However, suicidality in children ages 10 and younger has not been researched separately from suicidality in adolescents and adults. Data in this qualitative grounded theory study were derived from a content analysis of 22 treatment charts of suicidal children age 10 and younger, as well as 12 semi-structured interviews with experienced treatment providers. Findings indicate that childhood suicidality involves a full range of expression (ideation, behavior, attempts, and even completions), several common precipitating conditions (i.e., abuse and neglect, separation from a primary caregiver, negative familial influences, and mental and physical illness), trends in the methods of self-injury, and a set of commonly related psychiatric diagnoses and conditions.
Almquist, Y.B., et al. (2020). Association of child placement in out-of-home care with trajectories of hospitalization because of suicide attempts from early to late adulthood.JAMA Network Open. 2020;3(6), e206639. doi:10.1001/jamanetworkopen.2020.6639
A longitudinal Swedish study of (just under) 15 000 individuals that tries to determine if there is a relationship between children who had childhood experiences of out-of-home care (OHC) and subsequent hospitalization because of attempted suicide in early and late adulthood.
Abstract – Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited…Conclusions and Relevance: The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span.
O’Reilly, L.M., et al. (2020). The intergenerational transmission of suicidal behavior: An offspring of siblings study. Translational Psychiatry. 10:173 https://doi.org/10.1038/s41398-020-0850-6
This is another Swedish study. This one examines the suicidal behaviours of parents and the role of genetic and environmental factors on the suicidal behaviours of their offspring.
Abstract – We examined the extent to which genetic factors shared across generations, measured covariates, and environmental factors associated with parental suicidal behavior (suicide attempt or suicide) account for the association between parental and offspring suicidal behavior. We used a Swedish cohort of 2,762,883 offspring born 1973–2001. We conducted two sets of analyses with offspring of half- and full-siblings: (1) quantitative behavior genetic models analyzing maternal suicidal behavior and (2) fixed-effects Cox proportional hazard models analyzing maternal and paternal suicidal behavior. The analyses also adjusted for numerous measured covariates (e.g., parental severe mental illness). Quantitative behavior genetic analyses found that 29.2% (95% confidence interval [CI], 5.29, 53.12%) of the intergenerational association was due to environmental factors associated with exposure to maternal suicidal behavior, with the remainder due to genetic factors. Statistical adjustment for parental behavioral health problems partially attenuated the environmental association; however, the results were no longer statistically significant. Cox hazard models similarly found that offspring were at a 2.74-fold increased risk [95% CI, 2.67, 2.83]) of suicidal behavior if their mothers attempted/died by suicide. After adjustment for familial factors and measured covariates, associations attenuated but remained elevated for offspring of discordant half-siblings (HR, 1.57 [95% CI, 1.45, 1.71]) and full-siblings (HR, 1.62 [95% CI, 1.57, 1.67]). Cox hazard models demonstrated a similar pattern between paternal and offspring suicidal behavior. This study found that the intergenerational transmission of suicidal behavior is largely due to shared genetic factors, as well as factors associated with parental behavioral health problems and environmental factors associated with parental suicidal behavior.