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

🇨🇦 Kingsbury, M., Hammond, N., Johnstone, F. & Colman, I. (2022). Suicidality among sexual minority and transgender adolescents: A nationally representative population-based study of youth in Canada. Canadian Medical Association Journal, 194 (22), E767-E774. DOI: 10.1503/cmaj.212054
Data are culled from the 2019 Canadian Health Survey on Children and Youth to assess risk of suicidality among transgender and sexual minority adolescents in Canada.

Abstract – Background: Very little research has described risk of suicidal ideation and suicide attempt among transgender youth using high-quality, nationally representative data. We aimed to assess risk of suicidality among transgender and sexual minority adolescents in Canada. Methods: We analyzed a subsample of adolescents aged 15–17 years from the 2019 Canadian Health Survey on Children and Youth, a nationally representative, cross-sectional survey. We defined participants’ transgender identity (self-reported gender different from sex assigned at birth) and sexual minority status (self-reported attraction to people of the same gender) as exposures, and their self-reported previous-year suicidal ideation and lifetime suicide attempt as outcomes. Results: We included 6800 adolescents aged 15–17 years, including 1130 (16.5%) who indicated some degree of same-gender attraction, 265 (4.3%) who were unsure of their attraction and 50 (0.6%) who reported a transgender identity. Compared with cisgender, heterosexual adolescents, transgender adolescents showed 5 times the risk of suicidal ideation (95% confidence interval [CI] 3.63 to 6.75; 58% v. 10%) and 7.6 times the risk of suicide attempt (95% CI 4.76 to 12.10; 40% v. 5%). Among cisgender adolescents, girls attracted to girls had 3.6 times the risk of previous-year suicidal ideation (95% CI 2.59 to 5.08) and 3.3 times the risk of having ever attempted suicide (95% CI 1.81 to 6.06), compared with their heterosexual peers. Adolescents attracted to multiple genders had 2.5 times the risk of suicidal ideation (95% CI 2.12 to 2.98) and 2.8 times the risk of suicide attempt (95% CI 2.18 to 3.68). Youth questioning their sexual orientation had twice the risk of having attempted suicide in their lifetime (95% CI 1.23 to 3.36). Interpretation: We observed that transgender and sexual minority adolescents were at increased risk of suicidal ideation and attempt compared with their cisgender and heterosexual peers. These findings highlight the need for inclusive prevention approaches to address suicidality among Canada’s diverse youth population.

Bommersbach, T., Rosenheck R., Petrakis, I. & Rhee, T. (2022). Why are women more likely to attempt suicide than men? Analysis of lifetime suicide attempts among US adults in a nationally representative sample. Journal of Affective Disorders, 311, 157-164. DOI: 10.1016/j.jad.2022.05.096.
This American study using data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) explores why women attempt suicide more than men.

Abstract – Objective: While it is well-known that women are more likely to attempt suicide than men, little is known about risk and protective factors underlying this difference. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III), we compared women and men with and without self-reported lifetime suicide attempts to identify sociodemographic, clinical, and behavioral characteristics that were associated with suicide attempts for each gender. We then examined the interaction of gender and risk factors to identify specific factors that have a significantly different association with the risk of suicide attempts by gender. Multivariate analyses identified factors that were independently associated with a significant interaction of gender and risk of suicide attempt and the extent to which these interactions accounted for the greater risk of suicide attempts among women. Results: In unadjusted analysis, women had 1.78 greater odds of self-reported lifetime suicide attempts than men (95% confidence interval (CI), 1.61–1.96). While men and women shared similar risk and protective factors for suicide attempts, several factors were associated with significantly different risks for women than men. In multivariate analysis, these factors only partially accounted for the gender difference in lifetime risk of suicide attempt (adjusted odds ratio, 1.53; 95% CI, 1.12–2.08). Conclusions: Several risk factors for suicide attempts appear to have significantly different magnitude of association among women and men; however, these differences only partially account for gender difference in risk for suicide attempts, suggesting that other factors, not measured in this study, are at play.

Rodway, C., Tham, S., Richards, N., Ibrahim, S., Turnbull, P., Kapur, N., & Appleby, L. (2022). Online harms? Suicide-related online experience: A UK-wide case series study of young people who die by suicide. Psychological Medicine. DOI: 10.1017/S0033291722001258.
An analysis of young people aged 10-19 who died by suicide in the United Kingdom from 2014-2016. It was undertaken to determine the prevalence and significance of online activity in their deaths. The researchers utilized information on “the antecedents of suicide” from official investigations of 544 deaths.

Abstract – Background: Few studies have examined online experience by young people who die by suicide. Methods: A 3-year UK-wide consecutive case series of all young people aged 10–19 who died by suicide, based on national mortality data. We extracted information on the antecedents of suicide of 544 of these 595 deaths (91%) from official investigations, mainly inquests. Results: Suicide-related online experience was reported in 24% (n = 128/544) of suicide deaths in young people between 2014 and 2016, equivalent to 43 deaths per year, and was more common in girls than boys (OR 1.87, 95% CI 1.23–2.85, p = 0.003) and those identifying as LGBT (OR 2.35, 95% CI 1.10–5.05, p = 0.028). Searching for information about method was most common (n = 68, 13%), followed by posting suicidal ideas online (n = 57, 10%). Self-harm, bereavement (especially by suicide), social isolation, and mental and physical ill-health were more likely in those known to have suicide-related online experience compared to those who did not. 29 (5%) were bullied online, more often girls (OR 2.84, 1.34–6.04, p = 0.007). Online bullying often accompanied face-to-face bullying (n = 16/29, 67%). Conclusions: Suicide-related online experience is a common, but likely underestimated, antecedent to suicide in young people. Although its causal role is unclear, it may influence suicidality in this population. Mental health professionals should be aware that suicide-related online experience – not limited to social media – is a potential risk for young patients, and may be linked to experiences offline. For public health, wider action is required on internet regulation and support for children and their families.

Pergolizzi, J., Magnusson, P., LeQuang, J., Colucci, R., Breve, F. & Varrassi, G. (2022). Suicide, opioids, chronic pain, and mental health disorders: A narrative review. Addiction and Substance Use, 1(1), 15-19.
The intersection and interplay of opioid use and suicide is examined in this review. Many opioid overdose deaths are believed to be intentional but do not get reported as suicidal deaths.  The researchers look at the complex phenomena which may account for these occurrences.

Abstract – Suicide rates are on the rise in the United States as is mortality associated with opioid toxicity. According to the Centers for Disease Control and Prevention, about 7% of opioid overdose deaths are suicide, but this number may be under-reported. Many people who use opioids or have opioid use disorder, (OUD), may have “passive” intentions to commit suicide that are difficult to quantify. Further, both chronic pain and mental health disorders are prevalent in those who use opioids, and both are independently associated with suicide. It appears that suicide is associated with a trio of interlocking risk factors: opioids and opioid use disorder, chronic pain, and psychiatric illness. It is important to better understand the rising suicide rate so that appropriate efforts can be made to reduce it. While chronic pain, mental health disorders, and opioid use disorder are all associated with increased risk of suicide as individual factors, it is not known if they exert a synergistic effect that expose certain individuals to particularly elevated risks for suicidality.

Pisani, A., Gould, M., Gallo, C., Ertefaie, A., Kelberman, C., Harrington, D., Weller, D., & Green, S. (2022). Individuals who text crisis text line: Key characteristics and opportunities for suicide prevention. Suicide and Life-Threatening Behavior. DOI: 10.1111/sltb.12872
Studies of crisis lines which focus on service users who use chat or texting functions are sparse. This study analyses individuals who use Crisis Text Line (CTL), “the largest crisis text service in the United States.”

Abstract – Objective: Text-based crisis services are increasingly prominent, with inclusion in the national 988 crisis number launching in 2022. Yet little is known about who uses them. This study seeks to understand the population served by Crisis Text Line (CTL), the largest crisis text service in the United States. Methods: Secondary data analysis was conducted on de-identified Crisis Counselor reports, texter post-conversation survey responses, and anonymized text conversation data from 85,877 texters who contacted CTL during a 12-month period. We examined Crisis Counselor’s ratings of suicide ideation severity, texters’ reports of race, gender, sexual orientation, recent mental health symptoms, and additional sources of help, and logs of frequency of contact. Results: 76% of texters were under 25. 79% were female. 48% identified as other than heterosexual/straight. 64% had only one conversation. 79% were above the clinical cutoff for depression and 80% for anxiety, while 23% had thoughts of suicide. 23% received help from a doctor or therapist, and 28% received help only from CTL. Conclusions: CTL reaches a highly distressed, young, mostly female population, including typically underserved minorities and a substantial percentage of individuals who do not receive help elsewhere. These findings support the decision to include texting in the forthcoming national 988 implementation.

Lange, S., Kaplan, M., Tran, A. & Rehm, J. (2022). Growing alcohol use preceding death by suicide among women compared with men: age-specific temporal trends, 2003-2018. Addiction. DOI: 10.1111/add.15905.
The National Violent Death Reporting System (NVDRS) was used to determine the relationship between alcohol use and death by suicide among women and men in the years 2003-2018.

Abstract – Background and aims: In the United States, until 2018 both the prevalence of heavy alcohol use and the suicide mortality rate increased among men and women; however, women had experienced a notably higher increase in both. As heavy alcohol use may have contributed to the observed sex disparity in the suicide mortality rate increase, the aim of the current study was to estimate the temporal trend of the sex- and age-group-specific proportion of suicides that were alcohol-involved in the United States. Design: Using restricted-access data from the National Violent Death Reporting System, we performed join point regression analyses to investigate temporal trends in the sex- and age-group (young adults = 18–34 years; middle-aged adults = 35–64 years; and older adults = 65+ years)-specific proportion of suicides that were alcohol-involved. Setting: United States. Participants: A total of 115 202 suicide decedents 18+ years of age from 2003 to 2018. Measurements: The sex- and age-group-specific proportion of suicides that were alcohol-involved, among all suicide decedent, for which the decedent had a blood alcohol concentration (BAC) (a) ≥ 0.04 g/dl and (b) ≥ 0.08 g /dl. Findings: For 2003–18, the proportion of suicides that were alcohol-involved wherein the decedent had a BAC ≥ 0.08 g/day significantly increased on average annually for women of all age groups [young women: 2.80%, 95% confidence interval (CI) = 1.86%, 3.75%; middle-aged women: 2.20%, 95% CI = 1.20%, 3.21%; older women: 10.48%, 95% CI = 1.17%, 20.65%], while only middle-aged men experienced a significant average annual percentage increase (0.81%, 95% CI = 0.003%, 1.62%). Conclusion: In the United States between 2003 and 2018, alcohol use preceding death by suicide increased among women compared with men.

🇨🇦 Owais, S., Tsai, Z., Hill, T., Ospina, M., Wright, A. & Van Lieshout, R. (2022). Systematic review and meta-analysis: First Nations, Inuit, and Metis youth mental health. Journal of the American Academy of Child & Adolescent Psychiatry. DOI: 10.1016/j.jaac.2022.03.029.
28 studies were analyzed looking at the ongoing effects of colonialism, including historical trauma, on the mental health challenges among Indigenous youth in Canada.

Abstract – Objective: The ongoing effects of colonialism disproportionately place Indigenous youth at risk for mental health challenges. This meta-analysis examined lifetime and past-year prevalence estimates of mental health challenges among First Nations, Inuit, and Métis youth in Canada. Method: Five electronic databases were searched from their inceptions until June 17, 2021. Studies were included if they assessed mental health challenges among First Nations, Inuit, and/or Métis youth (≤18 years old). Risk of bias was assessed using the Newcastle−Ottawa Scale. Results: A total of 28 articles were eligible. Sixteen studies contained data on First Nations, 2 on Inuit, one on Métis, and 10 aggregated Indigenous participants. Among First Nations participants, pooled prevalence estimates for past-year suicidality (8.9%), mood and/or anxiety (<2.9%), attention-deficit/hyperactivity (2.9%), oppositional defiant (8.8%), and conduct (12.8%) disorder diagnoses were identified. Limited studies containing Inuit, Métis, and aggregated Indigenous participants also found high levels of disruptive disorder symptoms. Data were very limited for lifetime prevalence estimates. Studies assessed to have a moderate or high methodological risk of bias (k = 19) or using measures that are not yet culturally validated (k = 25) may contribute to inaccuracies in prevalence estimates. Conclusion: Existing data suggest that Indigenous youth have a low prevalence of mental health challenges, with the exception of disruptive behaviors. Future studies should use culturally validated tools and partner with Indigenous communities to ensure optimal identification of mental health challenges.

Doherty, A., Axe, C. & Joneset, D. (2022). Investigating the relationship between euthanasia and/or assisted suicide and rates of non-assisted suicide: Systematic review. BJPsych Open. DOI: 10.1192/bjo.2022.71
The authors conducted a systematic review of studies looking at the association between EAS (euthanasia and assisted suicide) and non-assisted suicide. They found six studies which met the inclusion criteria from four different jurisdictions: Switzerland, Netherlands, Belgium and the USA.

Abstract – Background: Euthanasia and assisted suicide (EAS) are practices that aim to alleviate the suffering of people with life-limiting illnesses, but are controversial. One area of debate is the relationship between EAS and suicide rates in the population, where there have been claims that availability of EAS will reduce the number of selfinitiated deaths (EAS and suicide combined). Others claim that legislation for EAS makes it acceptable to end one’s own life, a message at variance with that of suicide prevention campaigns. Aims: To examine the relationship between the introduction of EAS and rates of non-assisted suicide and self-initiated death. Method: We conducted a systematic review to examine the association between EAS and rates of non-assisted suicide and of self-initiated death. We searched PubMed, Scopus, PsycINFO and Science Direct, until 20 December 2021. Studies that examined EAS and reported data on population-based suicide rates were included. Results: Six studies met the inclusion criteria; four reported increases in overall rates of self-initiated death and, in some cases, increased non-assisted suicide. This increase in non-assisted suicide was mostly non-significant when sociodemographic factors were controlled for. Studies from Switzerland and Oregon reported elevated rates of self-initiated death among older women, consistent with higher rates of depressive illnesses in this population. Conclusions: The findings of this review do not support the hypothesis that introducing EAS reduces rates of non-assisted suicide. The disproportionate impact on older women indicates unmet suicide prevention needs in this population.

Haase, E., Schönfelder, A., Nesterko, Y. & Glaesmer, H. (2022). Prevalence of suicidal ideation and suicide attempts among refugees: A meta‑analysis. BMC Public Health, 22(635). DOI :10.1186/s12889-022-13029-8.
This is a review of studies that examine suicidal ideation and attempted suicide among refugees and asylum seekers. 11 papers met the requirements for inclusion in the review.

Abstract – Background: Suicidal ideation and attempts are one of the most serious mental health problems affecting refugees. Risk factors such as mental disorders, low socio-economic status, and stressful life events all contribute to making refugees a high-risk group. For this reason, this meta-analysis aims to investigate the prevalence of suicidal ideation and attempts among refugees in non-clinical populations. Method: We searched PubMed, Web of Science, PubPsych, and PsycInfo for articles reporting (period) prevalence rates of suicidal ideation and attempts. Inclusion criteria were the population of refugees or asylum seekers (aged 16 years and older), assessment of the prevalence of suicidal ideation and attempts in empirical studies in cross-sectional or longitudinal settings, written in English, and published by August 2020. Exclusion criteria were defined as a population of immigrants who have lived in the host country for a long time, studies that examined children and adolescents younger than 16 years, and research in clinical samples. Overall prevalence rates were calculated using Rstudio. Results: Of 294 matches, 11 publications met the inclusion criteria. The overall period prevalence of suicidal ideation was 20.5% (CI: 0.11–0.32, I2 = 98%, n = 8), 22.3% (CI: 0.10–0.38, I2 = 97%, n = 5) for women, and 27.7% for men (CI: 0.14–0.45, I2 = 93%, n = 3). Suicide attempts had an overall prevalence of 0.57% (CI: 0.00–0.02, I2 = 81%, n = 4). Conclusion: There is a great lack of epidemiological studies on suicidal ideation and attempts among refugees. The high prevalence of suicidal ideation indicates the existence of heavy psychological burden among this population. The prevalence of suicide attempts is similar to that in non-refugee populations. Because of the large heterogeneity between studies, the pooled prevalence estimates must be interpreted with caution. The results underline the need for systematic and standardized assessment and treatment of suicidal ideation and attempts.          

Na, P., Stefanovics, E., Rhee, T. & Rosenheck, R. (2022). “Lives of despair” at risk for “deaths of despair”: Tracking an under‑recognized, vulnerable population. Social Psychiatry and Psychiatric Epidemiology, 57, 1123–1134. DOI:10.1007/s00127-022-02218-w.
This study looks at deaths from drug-overdoses, alcohol-related liver disease and suicide (which have been called “deaths of despair”) and those American citizens affected most severely.

Abstract – Purpose: The substantial and unexpected increase in “deaths of despair” in the US (e.g., deaths from drug overdose, suicide, and alcohol-related liver diseases) reported by economists Case and Deaton in 2015 raises questions about the number and characteristics of US adults potentially living “lives of despair” with these problems. Methods: We used data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) to examine population estimates and characteristics of adults with lifetime history of substance use disorder (SUD) and suicide attempt, or either condition alone, as compared to those with neither. Results: An estimated 7.2 million adults had both lifetime SUD and suicide attempt and 78.8 million had either. Those with both faced far more psychosocial adversities, familial adverse experiences and psychiatric disorders compared to those with the other two groups, and reported greater mental health service utilization. Multivariable analysis showed that psychiatric multimorbidity and violence were the strongest correlates of having both conditions as compared to neither while those with either condition fell in between. Conclusion: A substantial number of US adults live with a lifetime SUD and suicide attempt with a multiplicity of additional socioeconomic, psychiatric and familial problems. While their utilization of mental health care service exceeds those with either or neither conditions, quality of life remained much poorer, suggesting that mental health treatment alone may not be enough to mitigate their sufferings, and a combination of both social policy support and quality mental health care may be needed.

Iverson, G. & Karr, J. (2022). Association between concussions and suicidality in high school students in the United States. Frontiers in Neurology, 13. DOI:10.3389/fneur.2022.810361.
Possible associations between concussions and suicidal behaviours among high school students in the United States were analyzed using data from the 2019 Youth Risk Behavior Surveillance (YRBS) system.

Abstract – Objective: To examine whether sustaining a concussion remained a significant predictor of suicidality after controlling for relevant covariates (e.g., sexual abuse/assault, bullying, substance use, depression), hypothesizing that the relationship between concussion and suicidality would become non-significant after controlling for these variables. Design: This study involved secondary data analysis of the 2019 Youth Risk Behavior Surveillance (YRBS) System, a national cross-sectional study of adolescents. Analyses were stratified by gender. Setting: A national sampling of U.S. high school students. Participants: Eleven thousand two hundred sixty-two students in the YRBS database, including 5,483 boys and 5,779 girls. Exposure(s): Participants included in the analyses reported whether, in the last year, they experienced a concussion and/or suicidality. Main Outcomes and Measures: The main outcome was suicidality (i.e., ideation, planning, attempt), which was predicted by concussion in an unadjusted analysis and by concussion along with other risk factors in a multivariable analysis. Results: The final sample included 11,262 participants with available data on concussion and suicidality in the last year (14–18 years-old; 51.3% girls; 49.0% White). Per unadjusted odds ratios with 95% confidence intervals, there was a relationship between concussion and suicidal ideation [girls: OR = 1.46 (1.24, 1.73); boys: OR = 1.69 (1.41, 2.03)], planning (girls: OR = 1.39 [1.16, 1.66]; boys: OR = 1.76 [1.44, 2.14]), and attempt [girls: OR = 1.70 (1.32, 2.19); boys: OR = 3.13, (2.37, 4.15)]. These relationships became mostly non-significant after controlling for relevant risk factors for suicidality. The adjusted odds ratios showed no relationship between concussion and suicidal ideation [girls: OR = 1.11 (0.86, 1.44); boys: OR = 1.24 (0.92, 1.69)] or planning (girls: OR = 1.07 [0.82, 1.40]; boys: OR = 1.12 [0.82, 1.55]); but a significant relationship with suicide attempts in boys [OR = 1.98 (1.28, 3.04)], but not girls [OR = 1.05 (0.74, 1.49)]. Conclusions and Relevance: There was an association between concussion and suicidality in U.S. high school students; however, after controlling for other variables (e.g., depression, sexual abuse/assault, illicit drug use), there was no association between concussion and suicidality aside from a significant relationship between concussion and attempts in boys.

Fitzpatrick, S., Brew, B., Handley, T. & Perkins, D. (2022). Men, suicide, and family and interpersonal violence: A mixed methods exploratory study. Sociology of Health & Illness. DOI:10.1111/1467-9566.13476.
This Australian study looks at data culled from the National Coronial Information System (NCIS). 155 suicide cases were identified involving intimate partner violence and these were analyzed to determine the how suicide and interpersonal violence may relate.

Abstract – Research has shown a link between gender, violence, and suicide. This relationship is complex, and few empirical studies have explored suicide and family and interpersonal violence perpetrated by men. Drawing on a coronial dataset of suicide cases and a mixed  methods design, this study integrated a quantitative analysis of 155 suicide cases with a qualitative analysis of medico-legal reports from 32 cases. Findings showed different types and patterns of family and intimate partner violence for men who died by suicide. Men used  violence in response to conflict, but also to dominate women. Cumulative, interwoven effects of violence, mental illness, alcohol and other drug use, socioeconomic, and psychosocial circumstances were observed in our study population. However, the use of violence and suicidal behaviour was also a deliberate and calculated response by which some men sought to maintain influence or control over women. Health and criminal justice interventions served as short-term responses to violence, mental illness, and suicidal  behaviour, but were of limited assistance.

🇨🇦 Liu, L., Pollock, N., Contreras, G., Tonmyr, L. & Thompson, W. (2022). Prevalence of suicidal ideation among adults in Canada: Results of the second Survey on COVID-19 and mental health. Health Reports, 33(5), 1-11. DOI:10.25318/82-003-x202200500002-eng.
This is a second round of surveys conducted among Canadians during the Covid pandemic gauging prevalence of suicidal ideation. This was conducted in the spring of 2021. Results were contrasted with the previous survey in fall of 2020 and the pre-pandemic period in 2019.

Abstract – Introduction: Data from the first round of the nationally representative Survey on COVID-19 and Mental Health (SCMH) revealed that the prevalence of recent suicidal ideation in the fall of 2020 in Canada did not differ significantly from that in the pre-pandemic period in 2019. The objective of the present study was to reassess the prevalence of recent suicidal ideation in the spring of 2021. Methods: The prevalence of suicidal ideation among adults in Canada was examined using the 2021 SCMH (conducted between February 1 and May 7, 2021), and it was compared with the prevalence in the 2019 Canadian Community Health Survey. Unadjusted logistic regression analysis was used to assess the differential likelihood of reporting suicidal ideation in population subgroups. Results: Among adults in Canada, the prevalence of suicidal ideation since the pandemic began was 4.2%, which was significantly higher than the pre-pandemic prevalence of 2.7% in 2019. A statistically significant increase in prevalence was observed among females and males, age groups younger than 65, and several other sociodemographic groups, as well as in British Columbia, the Prairie provinces and Ontario. People who were younger than 65 years, were born in Canada, had lower educational attainment, or were never married were significantly more likely to report suicidal ideation than others during the pandemic. Conclusion: As the second year of the pandemic began, the prevalence of recent suicidal ideation in Canada was higher than it had been before the pandemic in 2019. Continuous monitoring of suicide-related outcomes and risks is necessary so that population-level changes can be detected and inform public health action.

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