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

🇨🇦 Barry, R. et al. (2023). The relationship between rurality, travel time to care and death by suicide. BMC Psychiatry.   

This is an extension of a previous study by the authors looking at the relationship between suicide and rural factors. In this study, they add in the variable of “travel time to psychiatric and general hospitals” to measure its effect on suicide. 

Abstract –Background: We previously found an association between rurality and death by suicide, where those living in rural areas were more likely to die by suicide. One potential reason why this relationship exists might be travel time to care. This paper examines the relationship between travel time to both psychiatric and general hospitals and suicide, and then determine whether travel time to care mediates the relationship between rurality and suicide. Methods: This is a population-based nested case-control study. Data from 2007 to 2017 were obtained from administrative databases held at ICES, which capture all hospital and emergency department visits across Ontario. Suicides were captured using vital statistics. Travel time to care was calculated from the resident’s home to the nearest hospital based on the postal codes of both locations. Rurality was measured using Metropolitan Influence Zones. Results: For every hour in travel time a male resides from a general hospital, their risk of death by suicide doubles (AOR = 2.08, 95% CI = 1.61–2.69). Longer travel times to psychiatric hospitals also increases risk of suicide among males (AOR = 1.03, 95%CI = 1.02–1.05). Travel time to general hospitals is a significant mediator of the relationship between rurality and suicide among males, accounting for 6.52% of the relationship between rurality and increased risk of suicide. However, we also found that there is effect modification, where the relationship between travel time and suicide is only significant among males living in urban areas. Conclusions: Overall, these findings suggest that males who must travel longer to hospitals are at a greater risk of suicide compared to those who travel a shorter time. Furthermore, travel time to care is a mediator of the association between rurality and suicide among males. 

🇨🇦 Cha, M. et al. (2023). Concordance between the Columbia-Suicide Severity Rating Scale and Beck Scale for Suicide Ideation in assessing suicide behaviour in young adults with schizophrenia spectrum disorders. Psychiatry Research.  

The Columbia-Suicide Severity Rating Scale and the Beck Scale for Suicide Ideation are compared as predictive tools for attempted suicide in young adults with schizophrenia spectrum disorders. There were 202 participants in the study, ranging in age from 18-40. 

Abstract – The Columbia Suicide Severity Rating Scale (C–SSRS) is considered the gold standard for collecting information on suicidal ideation and behavior by the Food and Drug Administration (FDA) of the United States. To determine the accuracy of the C-SSRS compared to the Beck Scale for Suicidal Ideation (BSS) for collecting suicide attempt history in the schizophrenia population, 202 participants aged 18–40 with schizophrenia spectrum disorders were administered the C-SSRS, followed by the BSS. Medical charts were reviewed to confirm the lifetime history of actual suicide attempts. The BSS had an 83.5% accuracy in reporting single suicide attempts and 81.7% for multiple suicide attempts; while the C-SSRS had 84.1% and 83.9% accuracy respectively. This difference was not statistically significant (p = 0.849). Both the BSS and C-SSRS demonstrated high sensitivity and specificity in collecting suicide attempt history for young patients with psychosis, with no significant differences. Future investigators may choose the scale that is best suited to the level of detail required. 

Harris, D. & Krishnan, A. (2023). Exploring the association between suicide prevention public service announcements and use comments on YouTube: A computational text analysis approach. Journal of Health Communication.   

Suicide prevention public service announcements (PSAs) posted on YouTube and subsequent comments were analyzed for “for gain/loss-framing” and “narrative/argument-format.” 

Abstract – In the United States, suicide rates have increased by 30% over the past few decades. Public service announcements (PSAs) are effective health promotion vehicles and social media can help spread PSAs to hard-to-engage individuals who may benefit from intervention efforts, yet the most meaningful characteristics of PSAs for influencing health promotion attitudes and behaviors are inconclusive. This study applied content and quantitative text analyses to suicide prevention PSAs and comments on YouTube to assess the relationships between message frame, message format, and the level of sentiment and help-seeking language within them. Seventy-two PSAs were analyzed for gain/loss-framing and narrative/argument-format, and 4,335 related comments were analyzed for positive/negative sentiment and frequency of help-seeking language use. Results indicate that a higher ratio of positive comments was more likely to be found on gain-framed and narrative-formatted PSAs, and a higher ratio of comments with help-seeking language was more likely to be found on narrative-formatted PSAs. Implications and future research are discussed. 

Henkind, R. et al. (2023). Suicide among persons experiencing homelessness. Journal of Surgical Research.   

The authors use 2003-2018 data from the National Violent Death Reporting System (NVDRS) to compare factors surrounding suicidal deaths of People Experiencing Homelessness (PEH) to suicidal deaths of those housed. 

Abstract – Introduction: This study aims to characterize suicide and associated disparities among persons experiencing homelessness (PEH). Materials and methods: We reviewed suicide victims in the National Violent Death Reporting System (NVDRS) from 2003 to 2018 and compared factors surrounding suicides of PEH to factors of housed victims. We also utilized the Point-in-Time (PIT) survey (2010-2018), and census population estimates, to estimate suicide rates among PEH and the wider population. Results: 1.1% of suicide victims were described as experiencing homelessness at the time of their deaths, a value that is disproportional given the overall homeless rates of 0.2% in the past decade. Compared to nonhomeless victims, PEH were more likely to be younger, Black, male, and nonveterans. PEH were significantly more likely to have an identified alcohol/substance use disorder. PEH were half as likely to die via firearm and were more likely to die in natural areas, motels, and the streets. PEH were significantly more likely to have a history of suicidal thoughts, a history of suicide attempts, and a history of disclosure of intent, particularly to health care workers. Conclusions: PEH are disproportionately overrepresented among all suicide victims, but the circumstances surrounding their deaths create opportunity for targeted interventions. 

Hill, R.M. & McCray, C.L. (2023). Suicide-related stigma and social responsibility moderate the effects of an online suicide prevention gatekeeper training program. Archives of Suicide Research. DOI: 10.1080/13811118.2023.2199802  

The effects of stigma and social responsibility on the efficacy of an online suicide prevention training program called The Texas ASK? Suicide Gatekeeper Training Program were undertaken in this study. 

Abstract – Aim: Gatekeeper interventions are universal programs designed for use by the general public that provide brief training sessions in responding to suicidal risk. To date, the evidence base for the efficacy of gatekeeper intervention training programs has been mixed. However, little attention has been paid to potential psychological moderators of the efficacy of suicide gatekeeper interventions. We explore the potential moderating effects of suicide-related stigma and social responsibility on the efficacy of a suicide prevention gatekeeper training program. Methods: Participants were 179 college students with a mean age of 19.05 years (SD = 1.82, range 18–31). Participants were 71.5% women, 48.6% Hispanic, and 19.6% non-Hispanic White. Results: Results indicated that higher scores on suicide-related stigma were associated with smaller intervention effects on gatekeeper self-efficacy. In contrast, higher scores on social responsibility were associated with greater intervention effects with regard to gatekeeper preparedness and gatekeeper likelihood. Conclusion: An improved understanding of the factors associated with efficacy of gatekeeper intervention programs may lead to the development of improved gatekeeper interventions. These findings may also contribute to the development of targeted gatekeeper interventions for specific cultural or occupational groups.

La Sala et al. (2023). Acceptability and potential impact of the #chatsafe suicide postvention response among young people who have been exposed to suicide: Pilot study. JMIR Human Factors.    

#Chatsafe is an Australian intervention and social media campaign designed to educate young people about how to communicate safely about suicide. This study examined its effects on a final sample of 266 Australian young people. 

Abstract – Background: Young people are more likely to be affected by suicide contagion, and there are concerns about the role social media plays in the development and maintenance of suicide clusters or in facilitating imitative suicidal behavior. However, social media also presents an opportunity to provide real-time and age-appropriate suicide prevention information, which could be an important component of suicide postvention activities. Objective: This study aimed to test an intervention designed to equip young people to communicate safely online about suicide (#chatsafe) with a sample of young people who had recently been exposed to a suicide or suicide attempt, with a view to determining the role social media can play as part of a postvention response. Methods: A sample of 266 young people from Australia, aged 16 to 25 years, were recruited to participate in the study. They were eligible if they had been exposed to a suicide or knew of a suicide attempt in the past 2 years. All participants received the #chatsafe intervention, which comprised 6 pieces of social media content that were sent to them weekly via direct message through Instagram, Facebook, or Snapchat. Participants were assessed on a range of outcome measures (social media use, willingness to intervene against suicide, internet self-efficacy, confidence, and safety when communicating about suicide on social media platforms) at baseline, immediately after the intervention, and at 4-week follow-up. Results: After the 6-week #chatsafe intervention, participants reported substantial improvements in their willingness to intervene against suicide online, their internet self-efficacy, and their perceived confidence and safety when communicating about suicide online. Overall, the participants reported that it was appropriate to receive the #chatsafe intervention via social media, and no iatrogenic effects were recorded. Conclusions: The findings suggest that it is safe and acceptable to disseminate suicide prevention information entirely via social media among young people who have recently been exposed to a suicide or suicide attempt. Interventions such as #chatsafe could potentially mitigate the risk of distress and future suicidal behavior in young people by improving the quality and safety of online communication about suicide and, as such, can be an important component of delivering a postvention response to young people.  

Li, P. et al. (2023). Suicidal ideation and its relationship with mental health reported by different informants among children aged 6–12. Journal of Affective Disorders.   

This is a Chinese study of suicidal ideation in children aged 6 to 12. In contrast with adolescents, research is lacking on the prevalence of suicidal ideation among children. 

Abstract – Background: Suicidal ideation in children has received less attention than in adolescents. This study aimed to explore the self-reported prevalence of suicidal ideation among children aged 6-12 and to identify the relationship between self-reported suicidal ideation and children’s mental health reported by different informants in Chinese setting. Method: The study sample was 1479 children aged 6-12 from three elementary schools in Tianjin. Children completed the Dominic Interactive to report their mental health and suicidal ideation. Parents and teachers completed the Socio-Demographic Questionnaire and the Strengths and Difficulties Questionnaire (SDQ). Results: The prevalence of suicidal thoughts and death thoughts was 18.05 % and 16.90 %, respectively. Parent reported emotional symptoms, ADHD, and externalized problems were associated with death thoughts, and ADHD was associated with suicidal thoughts. For teacher’s reports, emotional symptoms, and impact were associated with death thoughts, and ADHD, peer problems, internalized problems, and internalized and externalized comorbidity were associated with suicidal thoughts. All of the children’s self-reported mental health problems were associated with suicidal thoughts and death thoughts. Limitations: Causality cannot be inferred in a cross-sectional study. Conclusion: Suicidal ideation is not uncommon in Chinese children. The relationships between mental health problems and suicidal ideation varied in different informants. Suicide prevention in young children should be enhanced, and screening for suicidal ideation is recommended at the onset of different informants who reported specific mental health problems. 

🇨🇦 Mishara, B. & Tran, A. (2023). Protocol for an implementation science evaluation of Roots of Hope: A community suicide prevention project. JMIR Research Protocols. DOI: 10.2196/39978

This is a protocol for an evaluation of Roots of Hope, a community suicide prevention project initiated by the Mental Health Commission of Canada (MHCC). The proposal calls for the evaluation to be implementation-science based. 

Abstract – Background: Roots of Hope (RoH) is a multi-site Canadian community-based suicide prevention initiative developed by the Mental Health Commission of Canada (MHCC), based on their review of the evidence for effectiveness of interventions and World Health Organization recommendations. Each of seven communities developed local activities in five “pillars”: Specialized Supports, Training and Networks, Public Awareness, Means Safety, and Evaluation Research. Objective: To use an Implementation Research (IR) approach to understand the RoH model for reducing suicidal behaviors and their impact in communities and lessons learned for the equitable development and implementation of RoH in different contexts; to understand how the program is implemented in relation to the context, causal pathways and factors influencing successful implementation. The evaluation includes assessments of short-term and intermediate effects at each site and overall. Methods: The Principal Investigator developed a consensus among the local Research Coordinators on common approaches and indicators through ongoing participation in an online Community of Practice and regular virtual and in-person meetings. At the completion of the pilot phase, he will summarize evaluation results across sites and conduct pooled analyses. The RoH Theory of Change and Evaluation Model shows how evaluation activities from the Planning Phase through the Implementation of activities in each of the pillars can help clarify the viability of the RoH model and identify factors that facilitate and inhibit effective and equitable implementation in different contexts. Beginning with a Situational Analysis to identify resources in each community and local specificities, we will examine implementation characteristics of: conformity, dosage, coverage, quality, utility, equity, appreciation, facilitators and impediments. Evaluation of short-term effects will focus on changes in: knowledge, attitudes, behaviors, help seeking, use of services, stigma, media reports, empowerment and experiences of care. Intermediate effects, long-term effects and impact include assessments of changes in suicides, suicide attempt rates, and suicide risk indicators. A variety of data sources, both quantitative and qualitative will be used, including: standardized questionnaires, examination of key documents, focus groups and interviews with coordinators, stakeholders, key informants, clients, persons with lived experience, and data on the incidence of suicidal behaviors that are available. Results: The quantitative and qualitative data from all sites will be summarized by the Principal Investigator in the Winter of 2023 in order to draw conclusions to help the MHCC in its improvements to the RoH model, and to inform communities about how to better implement the RoH approach in an efficacious and equitable manner. Since the Covid-19 pandemic occurred at the beginning of program implementation, the impact of the pandemic on the implementation and evaluation activities and its influence on the RoH project will be documented. Overall, we aim to clarify the validity of RoH in contributing to preventing suicides and suicidal behaviors in a variety of contexts. The final evaluation report should be available in 2023. Conclusions: The evaluation results, including the identification of factors that facilitate and inhibit the implementation of RoH and adaptations to challenges, should be of use to the MHCC, current RoH communities and those who are considering adopting the RoH model.

🇨🇦 Sicotte, R. et al. (2023). Heterogeneity in the course of suicidal ideation and its relation to suicide attempts in first-episode psychosis: A 5-year prospective study. The Canadian Journal of Psychiatry.   

382 First Episode Psychosis (FEP) patients were studied for suicidal ideation and attempted suicide over a 5-year period.

Abstract – Objectives: Although the risk of suicide is high in first-episode psychosis (FEP), little is known about the course of suicidal ideation and its relation to suicide attempts. Therefore, we aimed to identify 5-year trajectories of suicidal ideation and associated factors in FEP and compare how suicide attempts were distributed across these identified trajectories. Method: This 5-year prospective study assessed suicidal ideation, suicide attempts and potentially associated factors through research interviews, chart review and coroners’ reports in 382 FEP patients [mean age = 23.53 (SD = 3.61)] admitted to 2 5-year early psychosis services in Montreal, Canada. Trajectories were identified using a semiparametric mixture model, and associated factors with multinomial logistic regression. Results: Three suicidal ideation trajectories were identified: low and decreasing (n = 325, 85.08%); early decline, then increasing (n = 30, 7.85%), and persistent suicidal ideation (n = 27, 7.07%). Suicidal ideation prior to admission (OR = 2.85, 95% CI, 1.23 to 6.63, P < 0.05) and cocaine use disorder (OR = 6.78, 95% CI, 1.08 to 42.75, P < 0.05) were associated with the early decline, then increasing suicidal ideation trajectory. Persons with prior suicide ideation (OR = 4.33, 95% CI, 1.66 to 11.29, P < 0.05) and attempts (OR = 8.18, 95% CI, 2.39 to 27.97, P < 0.001) and alcohol use disorder (OR = 3.63, 95% CI, 1.4 to 9.42, P < 0.05) were more likely to belong to the persistent suicidal ideation trajectory, and to attempt suicide during follow-up. Conclusions: Our study highlights heterogeneity in the course of suicidal ideation over 5 years and the importance of ongoing assessment of suicidal risk in FEP patients, particularly for patients who persistently report suicidal ideation, as they are likelier to engage in suicide attempts. Patients with factors associated with increasing or persistent suicidal ideation trajectories should be targeted for suicide prevention interventions from the early phase of follow-up. Given the small number of persons in these trajectories and the wide CIs for some factors, larger studies are however needed to further characterize who belongs in each group.

Spafford, S. et al. (2023). Mental wellbeing and resilience in suicide prevention crisis line volunteers. Community Mental Health Journal.    

This current study aimed to explore mental wellbeing and resilience in suicide prevention crisis line volunteers. 20 volunteers from a suicide prevention line were surveyed at baseline, 3-month and 6 -month intervals, measuring mental wellbeing, resilience, help-seeking and other personal and professional factors. 

Abstract – Crisis line volunteers are critical to nationwide suicide prevention efforts as they provide free support services to those experiencing emotional distress or suicidality. Most crisis lines rely on volunteers for call-taking, however, the experiences of these volunteers and the impact of call-taking on their mental wellbeing remains understudied. The current study aimed to explore mental wellbeing and resilience in suicide prevention crisis line volunteers. In a longitudinal study among 20 volunteers of a suicide prevention crisis line, participants completed a series of three surveys at baseline, 3-month, and 6-month follow-up, measuring mental wellbeing, resilience, support, help-seeking, and other related personal and professional factors, including compassion satisfaction, burnout, and secondary traumatic stress. Results indicated that self-rated mental health was positively associated with willingness to seek help for an emotional problem from a doctor. Additionally, social support was negatively associated with burnout, but positively associated with compassion satisfaction. Finally, preparedness was negatively associated with secondary traumatic stress, while seeking help for an emotional problem or suicidality from a parent were both positively associated with secondary traumatic stress. Crisis line volunteers rated their mental health and compassion satisfaction highly and reported low levels of burnout and secondary traumatic stress. The role of social support and preparedness for call-taking deserve further investigation by researchers and crisis call centers as they may be critical to responders’ wellbeing.

🇨🇦 Thomson, A. et al. (2023). Rural perspectives on suicide prevention in Canada. Canadian Journal of Community Mental Health.

A qualitative study of rural men’s perspectives on suicide prevention. Virtual focus groups were arranged across six Canadian provinces to gather input from both rural community members and service workers. 

Abstract – Rural residence has been identified as a risk factor for suicide, especially for men. Little qualitative research exists on rural suicide, which might help deepen understandings of prevention strategies within rural places. Therefore, virtual focus groups were held across six Canadian provinces to give voice to rural community members and service workers about suicide prevention. Barriers to accessing services and the need to strengthen rural support networks were discussed. Enhancing peer support was highlighted as a strategy to better address the needs of rural Canadians.

Wu, R. et al. (2023). The effect of brief mindfulness meditation on suicidal ideation, stress and sleep quality. Archives of Suicide Research.27(2), 215-230.   

64 college students with a history of suicidal ideation were enrolled in either a Brief Mindfulness Meditation (BMM) group or a control group. Levels of suicidal ideation were subsequently measured in both groups.

Abstract – Objectives: Suicide is the fourth leading cause of death for individuals aged 15–29 years, and early intervention on suicidal ideation and risk factors should be prioritized. Brief mindfulness meditation (BMM) is convenient and cost-effective in improving physical and mental well-being, but less is known about its efficacy for suicidal ideation, stress and sleep quality. We investigated the effects of BMM on suicidal ideation, stress, and sleep quality for individuals with suicide risk. Methods: Sixty-four college students with high suicidal ideation (aged 18–30 years) were randomly allocated to either a BMM (n = 32) or control group (n = 32). The BMM was based on Anapanasati and core mindfulness concepts. Sixty participants completed all scheduled sessions including pretest, one month of intervention or waiting, and posttest. Suicidal ideation was measured with the Beck Scale for Suicidal Ideation. Stress was evaluated using the Perceived Stress Scale and salivary cortisol levels. Sleep was measured using the Pittsburgh Sleep Quality Index and actigraphy accompanied with 7-day sleep diaries. Results: Post-intervention, the BMM group showed significant decrease in suicidal ideation with a large effect size; the decrease showed a medium effect size in the control group. The BMM group, but not the control group, showed significant decrease in morning salivary cortisol and sleep latency, and improved sleep efficiency. Conclusions: BMM could help reduce suicidal ideation, stress, and sleep disturbance for individuals with high suicidal ideation and it may implicate effective suicide prevention strategy. 

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