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

🇨🇦 Ogrodniczuk, J.S., et al.  (2021). Psychosocial impact of the COVID-19 pandemic: A cross-sectional study of online help-seeking Canadian men. Postgraduate Medicine. DOI:10.1080/00325481.2021.1873027
A survey of the impact of COVID-19 on the help-seeking behaviours of Canadian adult men visiting HeadsUpGuys, an eHealth online resource.

Abstract – Purpose: The COVID-19 pandemic has had a profound impact on the lives of men. The present study investigated psychosocial impacts of the COVID-19 pandemic on a help-seeking sample of Canadian men, focusing on diverse aspects of their psychosocial well-being. Methods: A cross-sectional, open survey study design was used. Canadian adult men who were visiting an eHealth depression resource ( were recruited to complete an online survey. Descriptive statistics, including means and standard deviations for continuous variables and frequency and percentages for categorical variables, were used to summarize survey responses. Regression analysis was utilized to identify factors associated with various mental health indicators (anxiety, depression, fear of COVID-19, suicidality). The Patient Health Questionnaire-4, Fear of COVID-19 Scale, and item 9 (suicidality item) from the Patient Health Questionnaire-9 were used to assess the mental health indicators. Results: A total of 434 men completed the study. Most respondents (79.3%; N = 344) indicated that their mental health was negatively affected by COVID-19, and two-thirds (65.5%; N = 284) conveyed that government-imposed physical distancing measures had negatively affected their mental health. Half the sample (51.2%; N = 222) reported at least moderate financial stress due to COVID-19. Nearly a third of respondents (31.1%; N = 135) reported that their current living situation has had a considerable or severe negative impact on their mental health since COVID-19. About two-fifths (37.7%; N = 94) of men felt that COVID-19 has had a negative impact on their relationship with their intimate partner. Nearly a third of respondents who were in a relationship (30.9%; N = 77) reported that they engaged in some type of abuse (primarily verbal abuse, 22.9%; N = 57) toward their intimate partner during COVID- 19, and more than a quarter (27.3%; N = 68) reported being abused by their intimate partner (also primarily verbal abuse, 22.5%; N = 56). Just under half (42.2%; N = 183) of the respondents indicated experiencing suicidal ideation. Conclusion: These findings can help inform providers of health services to Canadian men, as well as policies that will be implemented during subsequent waves of COVID-19 or during future infectious outbreaks.

Chavez, L., et al. (2021). Housing First Combined with Suicide Treatment Education and Prevention (HOME+ STEP): Study protocol for a randomized controlled trial. BMC Public Health, 21, 1128. DOI:10.1186/s12889-021-11133-9
A protocol to determine the relationship between suicidal ideation and youth experiencing homelessness. From the abstract: “The primary objective is to determine whether housing combined with supportive services that include suicide screening and targeted psychotherapy (Cognitive Therapy for Suicide Prevention) is effective for reducing suicidal ideation and other secondary outcomes (depression and suicide attempts)”.

Abstract – Background: Youth experiencing homelessness are at high risk for suicide, yet few studies have evaluated risk reduction interventions targeting suicidal ideation in this vulnerable population. A comprehensive approach to risk-reduction is needed that addresses basic needs and provides targeted interventions for those at highest risk. The protocol described builds on the design of the first randomized trial of Housing First (HF) for homeless youth. The primary objective is to determine whether housing combined with supportive services that include suicide screening and targeted psychotherapy (Cognitive Therapy for Suicide Prevention) is effective for reducing suicidal ideation and other secondary outcomes (depression and suicide attempts). Additionally, we will explore mediators of the treatment effect (housing stability and substance use) and determinants of implementation. Methods: Youth recruited to the HF trial will be randomized to HF + supportive services (n = 120), or supportive services alone (n = 120). The “Suicide Treatment Education and Prevention” (STEP) protocol will additionally screen youth in both arms at baseline and 3 months for suicidal ideation (SSI-W). Those who screen as moderate risk for suicide (SSI-W ≥ 10) will be offered CTSP, which includes up to 9 sessions over the first 6 months following enrollment. CTSP will be delivered in one-on-one sessions by a trained advocate. Research assessments will be collected to assess outcomes (including suicidal ideation) at baseline, 3, 6, 9 and 12 months. Qualitative interviews with subjects receiving CTSP and other stakeholders will explore implementation determinants. Discussion: The study will fill an important gap in the literature about the added benefit of HF combined with supportive services including suicide screening and treatment for reducing suicidal ideation in homeless youth. With the urgent need to address both homelessness and suicide risk, evidence is needed about services that can be integrated into delivery settings for youth experiencing homelessness.

🇨🇦 Morton, M., et al. (2021). Gatekeeper training for friends and family of individuals at risk of suicide: A systematic review. Journal of Community Psychology, 1 – 34. DOI:10.1002/jcop.22624.
This is a systematic review of 17 studies examining gatekeeper training designed for family and friends of suicidal individuals (FFSI).

Abstract – Aims: Gatekeeper training (GKT) is an important suicide prevention strategy. Studies have evaluated the effectiveness of GKT in different populations, often neglecting family and friends who play a vital role in caring for people with suicide risk. This review evaluated GKT programs targeting family and friends to determine their effectiveness in this specific population. Methods: Academic databases were searched for studies on GKT programs. Programs involving family and friends caring for people with suicide risk were assessed for any impact on knowledge, self-efficacy, attitudes, and suicide prevention skills. Results: Seventeen studies were reviewed. GKT showed significant gains on outcomes of interest. Three studies targeted family and friends, with one involving them in program creation and conduction and another adjusting the program after their input. Conclusions: GKT programs have potentially positive effects on family and friends caring for people with suicide risk. Few programs address the specific needs of this group, and programs adapted specifically for them are scarce. Future program development recommendations are discussed.

Chen, Y-Y., et al. (2021). Caregiving as suicide-prevention: An ecological 20-country study of the association between men’s family carework, unemployment, and suicide. Social Psychiatry and Psychiatric Epidemiology. DOI:10.1007/s00127-021-02095-9
A study aiming to gauge whether men’s “family carework” has a relationship with unemployment and suicide rates.

Abstract – Purpose: Suicide rates are generally higher in men than in women. Men’s higher suicide mortality is often attributed to public-life adversities, such as unemployment. Building on the theory that men’s suicide vulnerability is also related to their private-life behaviors, particularly men’s low engagement in family carework, this ecological study explored the association between men’s family carework, unemployment, and suicide. Methods: Family-carework data for twenty Organization for Economic Co-operation and Development (OECD) countries were obtained from the OECD Family Database. Sex-specific age-standardized suicide rates came from the Global Burden of Disease dataset. The association between men’s engagement in family carework and suicide rates by sex was estimated, with OECD’s unemployment-benefits index and United-Nations’ Human Development-Index (HDI) evaluated as controls. The moderation of men’s carework on the unemployment-suicide relationship was also assessed. Results: Overall and sex-specific suicide rates were lower in countries where men reported more family carework. In these countries, higher unemployment rates were not associated with higher male suicide rates. In countries where men reported less family carework, higher unemployment was associated with higher male suicide rates, independent of country’s HDI. Unemployment benefits were not associated with suicide rates. Men’s family carework moderated the association between unemployment and suicide rates. Conclusion: This study’s findings that higher levels of men’s family carework were associated with lower suicide mortality, especially among men and under high-unemployment conditions, point to the suicide-protective potential of men’s family carework. They are consistent with evidence that where gender equality is greater, men’s and women’s well-being, health, and longevity are greater.

🇨🇦 Kia, H., et al. (2021). Peer support as a protective factor against suicide in trans populations: A scoping review. Social Science & Medicine, 279, 114026. DOI:10.1016/j.socscimed.2021.114026
Research reveals that there are higher rates of suicidal behaviours among transgender populations. This review examines studies of peer support as a protective factor against suicide for these communities.

Abstract – Rationale: There is a growing body of research involving transgender (trans) individuals that foregrounds elevated rates of suicidality in trans populations. Although peer support is increasingly studied as a protective factor against suicide among trans persons, the scholarship in this area continues to be limited and has yet to be synthesized and appraised. Objective: In this paper, we address this existing gap in the literature by presenting the results of a scoping review of the literature examining the significance and function of peer support in mitigating suicide risk in trans populations. Methods: This scoping review is based on an analysis of 34 studies that were included following the execution of a methodical search and selection process. Drawing on scoping review methodology, along with PRISMA-P guidelines, we selected peer-reviewed empirical works, published between 2000 and 2020, which examined relationships between providing, seeking, and/or receiving peer support and suicide risk in trans populations. Results: Our findings, which are conceptualized using the minority stress model as a guiding theoretical framework, reveal that while the literature generally substantiates the protective significance of peer support for trans persons, a small body of work also uncovers novel and unanticipated sources of peer support, including social support offered by trans peers online, which are infrequently and inconsistently examined in this body of scholarship. Conclusions: Using our appraisal of the literature, we outline the need for future research to further elucidate the significance and function of peer support in protecting against suicide among trans persons. In particular, we discuss the need for exploratory inquiry to inform a conceptualization and operationalization of peer support that more fully and consistently accounts for how such support (including online and community-based support) is sought, received, and experienced among trans persons in the context of suicide.

Brausch, A.M., et al. (2021). Body investment as a protective factor in the relationship between acquired capability for suicide and suicide attempts. Behavior Therapy. DOI:10.1016/j.beth.2021.02.008
The area of body investment (body feelings, body care, comfort with touch, and body protection) is looked at as a possible moderating factor between acquired capability for suicide and attempted suicide.

Abstract – Acquired capability for suicide is associated with increased suicide risk and behaviors, but little research has examined factors that may qualify this relationship. Body investment is proposed as one such factor, as it may engage self-preservation instincts and serve as a buffer to capability for suicide. It was expected that facets of body investment (body feelings, body care, comfort with touch, and body protection) would moderate the relationship between acquired capability for suicide and suicide attempts. The current study included a sample of 1,150 undergraduate students with a mean age of 19.74 (3.44). The majority of the sample identified as female (71%) and White/Caucasian (78%). Participants completed self-report measures of body investment (Body Investment Scale [BIS]), acquired capability (Acquired Capability for Suicide Scale [ACSS]), suicide thoughts and attempt history (Self-Harm Behavior Questionnaire [SHBQ]), and demographic information. Four moderation analyses were run using the PROCESS macro; one for each body investment subscale. All facets of body investment showed significant moderation except for body care. Acquired capability was significantly associated with suicide attempts when body feelings, comfort with touch, and body protection were low, but not when they were high. Results indicate that fostering aspects of body investment may be important for suicide prevention.

Vandoros, S. & Kawachi, I. (2021). Economic uncertainty and suicide in the United States. European Journal of Epidemiology. DOI:10.1007/s10654-021-00770-4
The authors analyze the potential association between economic uncertainty and increased rates of suicide. They cull data from the monthly economic uncertainty index and monthly suicide data at the state (USA) level from the time period 2000 to 2017.

Abstract – Previous studies have found an association between recessions and increased rates of suicide. In the present study we widened the focus to examine the association between economic uncertainty and suicides. We used monthly suicide data from the US at the State level from 2000 to 2017 and combined them with the monthly economic uncertainty index. We followed a panel data econometric approach to study the association between economic uncertainty and suicide, controlling for unemployment and other indicators. Economic uncertainty is positively associated with suicide when controlling for unemployment [coeff: 8.026; 95% CI: 3.692–12.360] or for a wider range of economic and demographic characteristics [coeff: 7.478; 95% CI: 3.333–11.623]. An increase in the uncertainty index by one percent is associated with an additional 11–24.4 additional monthly suicides in the US. Economic uncertainty is likely to act as a trigger, which underlines the impulsive nature of some suicides. This highlights the importance of providing access to suicide prevention interventions (e.g. hotlines) during periods of economic uncertainty.

Sedano-Capdevila, A., et al. (2021). Use of ecological momentary assessment to study suicidal thoughts and behavior: A systematic review. Current Psychiatry Reports, 23(41). DOI:10.1007/s11920-021-01255-7
Ecological momentary assessment (EMA) is an approach to patient evaluation that attempts to overcome shortcomings of traditional risk assessments. This review looked at 21 studies of EMA from 2007 to 2016.

Abstract – Purpose of Review: Ecological momentary assessment (EMA) is a recently introduced approach to patient evaluation that consists of asking patients questions in real time and in their usual habitat. This method seeks to contribute to suicide prevention by providing psychiatrists with detailed information about suicidal thoughts and behavior, how these fluctuate over short periods of time, and the short-term risk factors presented by patients. We conducted a systematic review of published research using EMA to study suicidal thoughts and behavior. Recent Findings: Several systematic reviews of EMA in mental health have been conducted to date, and the literature contains numerous theoretical papers and compilations on EMA and suicide phenomena. To date, however, no systematic reviews have explored the use of this tool to study suicidal thoughts and behavior. Summary: We performed a systematic review of five databases (i.e., PubMed, Embase, Scopus, Web of Science, and PsycINFO) to identify studies on EMA and suicidal thoughts and behavior. An initial search revealed 544 articles. Following the study selection process, 35 studies were included in the review. Almost three-quarters of the studies were published in the last 4 years. The studies reviewed concluded that EMA was generally feasible and well accepted. EMA findings correlated well with the results of a retrospective assessment, though tended to over-represent symptom severity. Our review points to important aspects of suicidal thoughts and behavior, such as its wide fluctuation over short periods of time. Negative affect and disturbed sleep, among others, emerged as short-term predictors of suicidal thoughts and behavior. Therefore, EMA is a potentially useful tool in clinical practice, although not without drawbacks, such as participant fatigue with questionnaires and ethical concerns.

Pruitt, Z., et al. (2021). Telehealth during COVID-19: Suicide prevention and American Indian communities in Montana. Telemedicine and eHealth. DOI:10.1089/tmj.2021.0104
A survey of health professionals who serve Indigenous peoples in Montana were asked whether the COVID-19 pandemic had increased the reliance on telehealth practices for them and their patients.

Abstract – Background: Public health measures that prevent the spread of COVID-19, such as social distancing, may increase the risk for suicide among American Indians due to decreased social connectedness that is crucial to wellbeing. Telehealth represents a potential solution, but barriers to effective suicide prevention may exist. Materials and Methods: In collaboration with Tribal and Urban Indian Health Center providers, this study measured suicide prevention practices during COVID-19. A 44-item Likert-type, web-based survey was distributed to Montana-based professionals who directly provide suicide prevention services to American Indians at risk for suicide. Descriptive statistics were calculated for survey items, and Mann–Whitney U tests examined the differences in telehealth use, training, skills among Montana geographic areas, and barriers between providers and their clients/patients. Results: Among the 80 respondents, two-thirds agreed or strongly agreed that American Indians experienced greater social disconnection since the COVID-19 pandemic began. Almost 98% agreed that telehealth was needed, and 93% were willing to use telehealth for suicide prevention services. Among current users, 75% agreed telehealth was effective for suicide prevention. Over one-third of respondents reported using telehealth for the first time during COVID-19 pandemic, and 30% use telehealth at least “usually” since the COVID-19 pandemic began, up from 6.3%. Compared with their own experiences, providers perceive their American Indian client/patients as experiencing greater barriers to telehealth. Discussion: Telehealth was increasingly utilized for suicide prevention during the COVID-19 pandemic. Opportunities to improve telehealth access should be explored, including investments in telehealth technologies for American Indians at risk for suicide.

Niederkrotenthaler, T. et al. (2021). Systematic review and meta-analyses of suicidal outcomes following fictional portrayals of suicide and suicide attempt in entertainment media. The Lancet, 36. DOI:10.1016/j.eclinm.2021.100922
A review by renowned scholars of suicidal contagion (Niederkrotenthaler, Pirkis, SInyor) who collected studies of fictionalized portrayals of suicide and analyzed its effects on society.

Abstract – Background: Guidelines to encourage responsible reporting of suicide in news media are a key component of suicide prevention strategies. Recent guidelines have been developed on portrayal of suicide in entertainment media although the relationship between these portrayals and subsequent suicidal behaviour has received considerably less attention in research. Methods: We conducted a systematic review and meta-analysis to examine the association between portrayals of suicide and suicide attempt in entertainment media and suicidal behaviour in the population. We searched PubMed, Scopus, Embase, PsycInfo, Web of Science and Google Scholar until April 20, 2021. We included studies adopting interrupted time series or single/multiple arm pre-post designs. Separate analyses were undertaken for studies of suicide and suicide attempts. We synthesized studies at moderate risk of bias and included studies at serious risk in a sensitivity analysis. Using a random-effects meta-analysis, we synthesized studies at moderate risk of bias and included studies at serious risk in a sensitivity analysis. Study registration: PROSPERO (CRD42020221333). Findings: Twelve studies met our inclusion criteria. Six studies were about suicide. Two of these were at moderate risk of bias and both examined the effects of the Netflix series 13 Reasons Why. The pooled rate ratio (RR) for these studies was 1·18 (95% CI 1·09 to 1·27, p<0·001). Heterogeneity was low (I2 = 29%). Six studies focused on suicide attempts, and two of them were at moderate risk of bias. The pooled RR for these two studies was 1·33 (95% CI 0·84 to 2·09, p = 0·22). Heterogeneity was high (I2 = 92%). Enhanced funnel plots indicated likely publication bias for studies of suicide and possible bias for studies of attempted suicide. Interpretation: Portrayals of suicide in entertainment media may increase suicides and attempted suicide in the population. More studies that limit the potential sources of bias are needed to fully understand the circumstances under which fictional portrayals may influence suicidal behaviour.

Van Zanden, B. & Bliokas, V. (2021). Taking the next step: A qualitative study examining processes of change in a suicide prevention program incorporating peer-workers. Psychological Services. DOI:10.1037/ser0000445
This study looks at the aftercare of those who have been discharged after a suicide attempt. The role of peer-workers in aftercare is increasingly recognized as timely and significant follow-up but research is sparse.

Abstract – Suicide is a leading preventable cause of death (Centers for Disease Control and Prevention, 2018). Recent research identifies the time following hospital discharge after a suicide attempt as a critical window whereby suicide risk is heightened. As a result, suicide aftercare services that emphasize timely follow-up intervention are increasingly popular. There is a lack of research exploring the role of peer-workers in the context of suicide prevention aftercare. This is surprising given that peer-work has been hypothesized to promote belongingness, engagement, and hope; all factors theorized as critical to suicide ideation and behavior. This project aimed to address this research gap by exploring the perspectives of six peer-workers and five clinicians (n = 11) employed in a suicide prevention aftercare program. Qualitative data were collected via an online survey and telephone interviews. Interviews explored what processes were perceived by peer-workers and clinicians as critical in facilitating change within the context of a suicide prevention service. Thematic analysis identified four themes encapsulating factors that promote change: (1) utilizing lived experience; (2) emotional availability of peers; (3) building lives worth living; and (4) consumer driven care. Our analysis also identified an additional, but less direct, mechanism of change: Consultation in the context of risk. Our findings show that peer-work in suicide prevention is regarded as largely positive by both peer-workers and clinicians. Peer-workers and clinicians highlighted the importance of collaboration and consultation to facilitate effective management of risk and supervision given the complex nature of suicide prevention work. Finally, workers emphasized the importance of promoting agency amongst service-users, which they viewed as particularly important within the context of suicide prevention. Implications for suicide services are discussed.

Subscribe to this monthly mailing list