Research Roundup – March 2022
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month:
Cardon, K. (2022). Suicide justice: Adopting Indigenous feminist methods in settler suicidology. Health, 26(1), 66-80. DOI: 10.1177/13634593211046837
Indigenous suicide in the United States is analysed through an Indigenous and feminist lens.
Abstract – White settler colonies around the world have long reported disproportionately high rates of Indigenous suicides, a consequence of the continuing violence of imperialism. This article posits a need for interdisciplinary approaches to address this crisis and therefore turns to humanist methods developed in Indigenous and feminist scholarship. I analyze texts from U.S. psychologist Edwin Shneidman to rearticulate their relationship to what I call settler suicidology. I then evoke literary critic Eve K. Sedgwick’s reparative reading method to reimagine suicide prevention as suicide justice, reading the novel There There by Tommy Orange (Cheyenne and Arapaho) to advocate for distributive justice as a new approach to Indigenous suicide crises. My term suicide justice names increasing accountability between settler suicide workers and the communities they seek to serve.
Van der Hallen, R. & Godor, B. (2022). Exploring the role of coping strategies on the impact of client suicide: A structural equation modeling approach. Omega. DOI: 10.1177/00302228211073213
This study looks at the incidence of client suicide and its effects on mental health practitioners who treat them.
Abstract – Client suicide refers to cases where a mental health practitioner is exposed, affected, or bereaved by a client’s suicide and is known to have a profound impact on MHPs. The current study investigated the role of coping styles in understanding short- and long-term impact of client suicide. An international sample of 213 mental health practitioners who experienced a client suicide completed a survey on coping strategies (i.e., Brief-COPE) and the impact of traumatic events (i.e., impact of event scale-revised, long-term emotional impact scale and professional practice impact scale). Results indicate coping strategies explain 51% of the short-term, 64% of the long-term emotional and 55% of the long-term professional differences in impact of client suicide. Moreover, while an Avoidant coping style predicted more impact of client suicide, Positive coping and Humor predicted less impact of client suicide. Social Support coping did not predict impact of client suicide. Implications for both research and clinical practice are discussed.
Fisher, K., Seidler, Z., King, K., Oliffe, J., Robertson, S., & Rice, S. (2022). Men’s anxiety, why it matters, and what is needed to limit its risk for male suicide. Discover Psychology. DOI: 10.1007/s44202-022-00035-5
Anxiety disorder and its relationship with male suicidality is examined in this study.
Anxiety disorders are the most prevalent mental health disorder experienced by men. If left untreated, anxiety is predictive of psychiatric disorders including depression and associated suicide risk. Despite the prevalence and impact of men’s anxiety, it remains largely overlooked in the field of men’s mental health. Globally, men are reported to have lower rates of anxiety disorders compared to women; however, these sex-differences do not reflect the complexity and nuance of men’s experiences. There is early evidence to suggest a male-type anxiety phenotype which may go undetected with generic diagnostic classifications. Masculine norms (i.e., stoicism, toughness, invulnerability) appear to be central to men’s experiences and expressions of anxiety as well as men’s help-seeking and coping behaviours. This is particularly concerning given anxiety increases men’s risk of physical and psychological comorbidities and suicide risk. The effective assessment, detection and treatment of men’s anxiety is therefore critical to improve mental health outcomes across the male lifespan. We propose three key recommendations for the field of men’s anxiety: (i) to develop a theoretical model surrounding men’s experiences of anxiety, (ii) broaden mental health resources, interventions and suicide prevention strategies to encompass men’s gendered experiences of anxiety (e.g., sentiments of shame, physical symptom manifestation), and (iii) utilise informal supports (i.e., friends and family) as an avenue of intervention to improve men’s anxiety outcomes. Without a substantial research agenda in men’s anxiety, we will fail to recognise and respond to men’s gendered experiences of anxiety and ultimately fail to reduce male suicides.
Hill, N., Bailey, E., Benson, R., Cully, G., Kirtley, O., Purcell, R., Rice, S., Robinson, J., & Walton, C. (2022). Researching the researchers: Psychological distress and psychosocial stressors according to career stage in mental health researchers. BMC Psychology. DOI: 10.1186/s40359-022-00728-5
An international cross-sectional study of mental health researchers was undertaken to gauge the prevalence of psychological stressors, psychological distress, and mental health diagnoses among them.
Abstract – Background: Although there are many benefits associated with working in academia, this career path often involves structural and organisational stressors that can be detrimental to wellbeing and increase susceptibility to psychological distress and mental ill health. This exploratory study examines experiences of work-related psychosocial stressors, psychological distress, and mental health diagnoses among mental health researchers. Methods: This international cross-sectional study involved 207 mental health researchers who were post-graduate students or employed in research institutes or university settings. Work-related psychosocial stressors were measured by the Copenhagen Psychosocial Questionnaire III (COPSOQ III). Psychological distress was assessed using the Depression-Anxiety-Stress Scale-21 (DASS-21). Thoughts of suicide was assessed using an adaptation of the Patient Health Questionnaire-9 (PHQ-9). History of mental health diagnoses was assessed through a custom questionnaire. Pearson’s chi-square test of independence was used to compare mental health diagnoses and suicidal ideation across career stages. The association between work-related psychosocial stressors and psychological distress was conducted using multivariate linear regression controlling for key demographic, employment-related and mental health factors. Results: Differences in ‘demands at work’ and the ‘work-life balance’ domain were lowest among support staff (p = 0.01). Overall, 13.4% of respondents met the threshold for severe psychological distress, which was significantly higher in students compared to participants from other career stages (p = 0.01). Among the subgroup of participants who responded to the question on mental health diagnoses and suicidal ideation (n = 152), 54% reported a life-time mental health diagnosis and 23.7% reported suicidal ideation since their academic career commencement. After controlling for key covariates, the association between the ‘interpersonal relations and leadership’ domain and psychological distress was attenuated by the mental health covariates included in model 3 (β = −0.23, p = 0.07). The association between the remaining work-related psychosocial stressors and psychological distress remained significant. Conclusions: Despite working in the same environment, research support staff report experiencing significantly less psychosocial stressors compared to postgraduate students, early-middle career researchers and senior researchers. Future research that targets key modifiable stressors associated with psychological distress including work organization and job content, and work-life balance could improve the overall mental health and wellbeing of mental health researchers.
Katsampa, D., Mackenzie, J.M., Crivatu, I., & Marzano, L. (2022). Intervening to prevent suicide at railway locations: Findings from a qualitative study with front-line staff and rail commuters. BJPsych Open. DOI: 10.1192/bjo.2022.27
A survey of UK-based men and women who had intervened in a suicidal situation at railway locations. Respondents described what methods they employed and their feelings and reflections after the intervention.
Abstract – Background: For every suicide on the British railway network, at least six potential attempts are interrupted by front-line staff or rail commuters. However, the factors that maximise or hinder the likelihood and effectiveness of such interventions are poorly understood. Aims: The aim of the current study was to shed light on the experience of intervening to prevent a suicide at a railway location, including how and why people intervene, and their feelings and reflections in the aftermath. Method: In-depth interviews were carried out with rail commuters (n = 11) and front-line railway staff (n = 10) who had intervened to stop a suicide by train. Data were analysed thematically. Results: Participants had intervened to prevent suicide in several ways, both from afar (e.g. by calling a member of staff) and more directly (verbally or non-verbally), in some cases with no prior training or experience in suicide prevention, and often as a ‘quick, gut reaction’ given the limited time to intervene. In more ‘reasoned’ interventions, poor confidence and concerns around safety were the greatest barriers to action. Although often privy to their final outcome, most participants reflected positively on their intervention/s, stressing the importance of training and teamwork, as well as small talk and non-judgmental listening. Conclusions: Suicides in railway environments can present bystanders with little time to intervene. Potential interveners should therefore be resourced as best as possible through clear infrastructure help/emergency points, visibility of station staff and training for gatekeepers.
🇨🇦 Taylor, P. (2022). Challenging the myth of “attention seeking” women with suicidality: A grounded theory study about applying counter-pressure to manage system entrapment. Issues in Mental Health Nursing. DOI: 10.1080/01612840.2021.2014608
This Canadian study looked at the help-seeking behaviours of women with experience of intimate partner violence and self-harming behaviours.
Abstract – Some women who express suicidal intent and engage in non-lethal self-harm perceive that nurses and other health care workers label them as attention-seeking and manipulative. An understanding of women’s help-seeking behaviors that challenges suicide myths is presented. The purpose of this study was to examine help-seeking for suicidality in women with histories of intimate partner violence using a multiple qualitative research design of grounded theory and photovoice. Women from New Brunswick, Canada, over the age of 19 who left an abusive partner (n = 32) were interviewed and seven local women from this sample participated in five photovoice group sessions where they collectively examined self-generated photos of their experiences. Transcripts of the interviews and group sessions were analyzed using the constant comparative approach, yielding a theoretical rendering of women’s help seeking. Results include a process of Applying Counter-Pressure as a way of pushing back against System Entrapment, or the sense of being invalidated and dehumanized by health care providers with the goal to Feel Human. Findings provide an understanding of women’s behavior when seeking help for suicidality and may reduce nurses’ assumptions and judgments when providing care. Trauma and violence informed care provides a framework from which to guide interventions that acknowledge the role of past and ongoing trauma in women’s lives, supporting nurses’ capacity to be validating and helping women to continue living.
Cogo, E., Murray, M., Villanueva, G., Hamel, C., Garner, P., Senior, S., & Hensche, N. (2022). Suicide rates and suicidal behaviour in displaced people: A systematic review. PLoS ONE. DOI: 10.1371/journal.pone.0263797
This systematic review looks at 77 studies of refugees, asylum seekers, and internally displaced people and incidence of suicide and suicidal behaviours.
Abstract – Background: Refugees, and other forcibly displaced people, face mental distress and may be disproportionately affected by risk factors for suicide. Little is known about suicidal behaviour in these highly mobile populations because collecting timely, relevant, and reliable data is challenging. Methods and findings: A systematic review was performed to identify studies of any design reporting on suicide, suicide attempts, or suicidal ideation among populations of displaced people. A sensitive electronic database search was performed in August 2020, and all retrieved studies were screened for relevance by two authors. Studies were categorised by the population being evaluated: refugees granted asylum, refugees living in temporary camps, asylum seekers, or internally displaced people. We distinguished between whether the sampling procedure in the studies was likely to be representative, or the sample examined a specific non-representative subgroup of displaced people (such as those already diagnosed with mental illness). Data on the rates of suicide or the prevalence of suicide attempts or suicidal ideation were extracted by one reviewer and verified by a second reviewer from each study and converted to common metrics. After screening 4347 articles, 87 reports of 77 unique studies were included. Of these, 53 were studies in representative samples, and 24 were based on samples of specific target populations. Most studies were conducted in high-income countries, and the most studied population subgroup was refugees granted asylum. There was substantial heterogeneity across data sources and measurement instruments utilised. Sample sizes of displaced people ranged from 33 to 196,941 in studies using general samples. Suicide rates varied considerably, from 4 to 290 per 100,000 person-years across studies. Only 8 studies were identified that compared suicide rates with the host population. The prevalence of suicide attempts ranged from 0.14% to 15.1% across all studies and varied according to the prevalence period evaluated. Suicidal ideation prevalence varied from 0.17% to 70.6% across studies. Among refugees granted asylum, there was evidence of a lower risk of suicide compared with the host population in 4 of 5 studies. In contrast, in asylum seekers there was evidence of a higher suicide risk in 2 of 3 studies, and of a higher risk of suicidal ideation among refugees living in camps in 2 of 3 studies compared to host populations. Conclusion: While multiple studies overall have been published in the literature on this topic, the evidence base is still sparse for refugees in camps, asylum seekers, and internally displaced people. Less than half of the included studies reported on suicide or suicide attempt outcomes, with most reporting on suicidal ideation. International research networks could usefully define criteria, definitions, and study designs to help standardise and facilitate more research in this important area.
🇨🇦 Toombs, E., Kowatch, K., Dalicandro, L., McConkey, S., Hopkins, C., & Mushquash, C. (2021). A systematic review of electronic mental health interventions for Indigenous youth: Results and recommendations. Journal of Telemedicine and Telecare, 27(9), 539-552. DOI: 10.1177/1357633X19899231
This systematic review looks at studies of electronic mental health interventions for Indigenous youth. The authors include recommendations for future actions in this area.
Abstract – Electronic health interventions involve health services delivered using the Internet and related communication technologies. These services can be particularly relevant for Indigenous populations who often have differential access to health-care services compared to general populations, especially within rural and remote areas. As the popularity of electronic health interventions grows, there is an increased need for evidence-based recommendations for the effective use of these technologies. The current study is a systematic review of peer-reviewed and available grey literature with the aim of understanding outcomes of electronic health interventions for mental health concerns among Indigenous people. Studies used electronic health technologies for substance use treatment or prevention, suicide prevention, parenting supports, goal setting and behaviour change and consultation services. Various technological platforms were used across interventions, with both novel and adapted intervention development. Most studies provided qualitative results, with fewer studies focusing on quantitative outcomes. Some preliminary results from the engagement of Indigenous individuals with electronic health services has been demonstrated, but further research is needed to confirm these results. Identified barriers and facilitators are identified from the reviewed literature. Recommendations for future development of electronic health interventions for Indigenous youth are provided.
Pothireddy, N., Lavigne, J., Groman, A., Carpenter, D. (2022). Developing and evaluating a module to teach suicide prevention communication skills to student pharmacists. Currents in Pharmacy Teaching and Learning. DOI: 10.1016/j.cptl.2022.02.002
A brief suicide prevention module called S.A.V.E. was implemented and adapted to a community pharmacy setting. It was introduced and taught to pharmacy students in 2 schools of pharmacy.
Abstract – Introduction: This study aimed to determine whether a brief educational intervention for student pharmacists about individuals who exhibit suicide warning signs improves knowledge and confidence to recognize suicide warning signs, ask about suicide, validate feelings, and expedite referrals. Methods: This longitudinal, observational study was conducted with student pharmacists from two pharmacy schools in 2019. Students completed a suicide prevention module adapted from the Veteran Administration’s S.A.V.E. suicide prevention gatekeeper training program (completion rate 67%). The module included a video case of an individual who exhibits suicide warning signs, a brief didactic lecture, and a role-play practice session. Text responses were coded by three independent raters. Students completed a multiple-choice pretest and posttest to assess knowledge and confidence. Paired samples t-tests were calculated to examine changes in students’ knowledge and confidence scores. Results: Students’ (N = 139) confidence and knowledge in recognizing and managing suicide warning signs improved significantly. There was improvement in how many students directly asked about suicide and expedited a referral. Most students (86%) reported planning to incorporate what they learned into practice. Conclusions: In two schools of pharmacy, a brief suicide prevention module was implemented and adapted to the community pharmacy setting, which improved pharmacy students’ knowledge and confidence to interact with an individual who exhibits suicide warning signs. S.A.V.E. teaches students how to communicate with an individual in crisis in a way that can be integrated into a busy pharmacy workflow, which may be why students planned to incorporate it into practice.
🇨🇦 Rassy, J., Daneau, D., Larue, C., Rahme, E., Low, N., Lamarre, S., Turecki, G., Bonin, J.P., Racine, H., Morin, S., Dasgupta, K., Renaud, J., & Lesage, A. (2022). Measuring the quality of care received by suicide attempters in the emergency department. Archives of Suicide Research. 26(1), 81-90. DOI: 10.1080/13811118.2020.1793043
A study of adult attempted suicide was conducted in 2 Montreal emergency departments. An existing checklist for quality of medical and social care in the ED was adapted for adult suicide attempters.
Abstract – Audits conducted on medical records have been traditionally used in hospitals to assess and improve quality of medical care but have yet to be properly integrated and used for suicide prevention purposes. We aimed to (1) revise a quality of care grid and adapt it to an adult population of suicide attempters and (2) identify quality of care deficits in managing adult suicide attempters at the emergency department (ED) in two different Montreal university hospitals. Methods: An existing checklist for quality of medical and social care in the ED was adapted. A systematic search and data extraction of all suicide attempters in two different Montreal university hospitals were then conducted. All identified individuals who attempted suicide were fully reviewed and quality of care was assessed. Results: Eleven criteria were kept by the expert focus group in the revised grid that was then used to rate 369 individuals that attempted suicide. Suicide risk assessment was only present in 63% of attempters before discharge. Although family history was documented for 90% of attempters, in only 41% of the cases were interviews conducted with relatives. Most discharged patient lacked proper follow-up considering 11% of their relatives received written information on resources in case of need.
Krishnamurti, L., Monteith, L., McCoy, I., Dichter, M. (2022). Gender differences in use of suicide crisis hotlines: A scoping review of current literature. Journal of Public Mental Health. DOI: 10.1108/JPMH-10-2021-0136
The authors aim to identify gender differences in suicide crisis hotline users. A review of 18 studies from 2000 to the present were identified.
Abstract – Purpose: Little is known about the gender profile of callers to crisis hotlines, despite distinct gender differences in suicide risk and behavior. The authors assessed current knowledge of the role of caller gender in the use of crisis hotlines for suicide, specifically whether there are differences in frequency, reason for call and caller outcomes by gender. Design/methodology/approach: The authors conducted a scoping literature review of peer-reviewed studies published since 2000 in Medline, PubMed and PsychInfo, examining a total of 18 articles based on 16 studies. Findings: Overall, women represent a higher percentage of calls to crisis hotlines worldwide, despite men having higher rates of suicide. Primary reasons for calling hotlines were the same for men and women, regardless of geography or culture. When gender differences in reason for call were reported, they were consistent with literature documenting gender differences in the prevalence of risk factors for suicide, including higher rates of substance use among men and higher instances of domestic violence/abuse among women. Research limitations/implications: There was variability in the studies the authors examined. This review was limited to research on crisis telephone hotlines and did not include text or chat services. Due to data reporting, the findings are constrained to reporting on a male/female gender binary. Originality/value: Findings on gender differences in crisis line use suggest a need for continued research in this area to determine how to best meet the needs of callers of all genders.
Benton, T. (2022). Suicide and suicidal behaviors among minoritized youth. Child & Adolescent Psychiatric Clinics, 31(2), 211-221. DOI: 10.1016/j.chc.2022.01.002
Most studies of youth suicide have focused on Caucasian youth. This article recognizes a need for more research examining suicidality among minoritized youth of colour, and associated disparities of recognition and treatment for racialized youth.
Abstract – Suicide rates continue to increase among children and adolescents in the United States, with suicide remaining the second leading cause of death for youth aged 10 to 24 years of age. Most studies of suicide among children and adolescents have not focused on youth of color because of research suggesting that suicide was a health threat for white youth. Research showing shifting trends in suicide for minoritized youth of color has increased national focus, revealing disparities in recognition and treatment of suicidal behaviors for racially and culturally diverse youth.
Clark, K. & Blosnich, J. (2022). “If I had access to a gun, I think I would have used it instead”. Motivations for method choice among sexual and minority adults who made a recent near-fatal suicide attempt. LGBT Health. DOI: 10.1089/lgbt.2021.0389
This qualitative study looks at the significance of choice of means of suicide among sexual and gender minority adults who experienced near-fatal suicide attempts.
Abstract – Purpose: We examined motivations for suicide attempt method choice among sexual and/or gender minority (SGM) adults who attempted suicide in the previous 18 months. Methods: Individual semistructured interviews (N = 22) explored participants’ motivations. Results: Five reasons influenced method choices: accessibility, perceived lethality, familiarity, not having access to a firearm, and concerns about pain and violence involved with other methods. Conclusion: Methods of suicide attempt are critical for informing SGM suicide prevention efforts. Future research should investigate whether and how lethal means restriction efforts are implemented within the contexts in which SGM people live and obtain mental health care (e.g., SGM community centers).
Chin, K., Wendt, A., Bennett, I., & Bhat, A. (2022). Suicide and maternal mortality. Current Psychiatry Reports. DOI: 10.1007/s11920-022-01334-3
A systematic review of studies examining the prevalence of suicide during the perinatal period (pregnancy and the subsequent year of post-partum).
Abstract – Purpose of Review: Suicide is a leading cause of death in the perinatal period (pregnancy and 1 year postpartum). We review recent findings on prevalence, risk factors, outcomes, and prevention and intervention for suicide during pregnancy and the first year postpartum. Recent Findings: Standardization of definitions and ascertainment of maternal deaths have improved identification of perinatal deaths by suicide and risk factors for perinatal suicide. Reports of a protective effect of pregnancy and postpartum on suicide risk may be inflated. Clinicians must be vigilant for risk of suicide among their perinatal patients, especially those with mental health diagnoses or prior suicide attempts. Summary: Pregnancy and the year postpartum are a time of increased access to healthcare for many, offering many opportunities to identify and intervene for suicide risk. Universal screening for suicide as part of assessment of depression and anxiety along with improved access to mental health treatments can reduce risk of perinatal suicide.