Research Roundup – March 2023
This is a summary of the latest Canadian () and international suicide research we collected in the past month:
🇨🇦 Smith, J. et al. (2023). A commentary on suicide prevention training: The process of implementing an ASIST pilot in postsecondary nursing education. Teaching and Learning in Nursing. https://doi.org/10.1016/j.teln.2023.02.011
This is a commentary on the suicide prevention landscape in the postsecondary nursing setting and a description of a pilot project delivering ASIST training to nursing students, faculty, and staff at the University of Calgary. UCalgary’s Faculty of Nursing and the Centre for Suicide Prevention co-authored the article.
Abstract – This commentary provides an overview of existing literature on suicide and suicide prevention in the context of postsecondary and nursing settings. WHO (2022) reported that more than 50% of the medical workforce are made up of nurses and midwives who are in an optimal position to provide care for individuals who may be at risk for suicide. Suicide continues to be a major public health issue in Canada, with the postsecondary student population being at a heightened risk for mental health crises. A best practice for suicide prevention is education. Applied Suicide Intervention Skills Training (ASIST) has been used and evaluated internationally by various institutions. We present a pilot project for the delivery of ASIST as both a co-curricular activity for nursing students and as professional development for faculty and staff. We include the process for implementing a pilot of ASIST within the postsecondary education setting, and an evaluation plan for the pilot project.
🇨🇦 Auger, N. et al. (2023). Suicide attempts in children aged 10-14 years during the first year of the COVID-19 pandemic. Journal of Adolescent Health. 7 1-7. DOI:10.1177/27550834231158188
Hospitalization rates for attempted suicide by adolescents were measured during the first year of the COVID-19 pandemic. Data were culled from the Maintenance and Use of Data for the Study of Hospital Clientele registry Quebec between January 2020 and March 2021.
Abstract – Purpose: To determine if suicide attempts increased during the first year of the pandemic among young adolescents in Quebec, Canada. Methods: We analyzed children aged 10-14 years who were hospitalized for a suicide attempt between January 2000 and March 2021. We calculated age-specific and sex-specific suicide attempt rates and the proportion of hospitalizations for suicide attempts before and during the pandemic and compared rates with patients aged 15-19 years. We used interrupted time series regression to measure changes in rates during the first (March 2020 to August 2020) and second (September 2020 to March 2021) waves and difference-in-difference analysis to determine if the pandemic had a greater impact on girls than boys. Results: Suicide attempt rates decreased for children aged 10-14 years during the first wave. However, rates increased sharply during the second wave for girls, without changing for boys. Girls aged 10-14 years had an excess of 5.1 suicide attempts per 10,000 at the start of wave 2, with rates continuing to increase by 0.6 per 10,000 every month thereafter. Compared with the prepandemic period, the increase in the proportion of girls aged 10-14 years hospitalized for a suicide attempt was 2.2% greater than that of boys during wave 2. The pattern seen in girls aged 10-14 years was not present in girls aged 15-19 years. Discussion: Hospitalizations for suicide attempts among girls aged 10-14 years increased considerably during the second wave of the pandemic, compared with boys and older girls. Young adolescent girls may benefit from screening and targeted interventions to address suicidal behavior.
Barlattani, T. (2023). Suicide and COVID-19: A rapid scoping review. Annals of General Psychiatry. https://doi.org/10.1186/s12991-0 23-00441-6
This is a rapid review of 53 studies examining the relationship between the COVID-19 pandemic and suicidal behaviours.
Abstract – There is considerable interest in exploring effects of coronavirus disease 2019 (COVID-19) pandemic on mental health. Suicide is one of the leading causes of mortality worldwide and changes in daily life brought by the pandemic may be additional risk factors in people with pre-existing mental disorders. This rapid PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) scoping review aims to identify and analyze current evidence about the relation between COVID-19 pandemic outbreak, along with COVID-19 disease and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and suicide in individuals with previously diagnosed mental disorders. First, we conducted a comprehensive review of the literature, then proceeded to discuss findings in a narrative way. Tables were constructed and articles sorted according to the studies’ methodologies. 53 papers were eventually identified as eligible, among which 33 are cross-sectional studies, 9 are longitudinal studies, and 11 studies using other methodologies. Despite suffering from a mental disorder is a risk factor for suicidal behavior per se, the advent of COVID-19 pandemic may exacerbate this relation. Nevertheless, data addressing a clear correlation between suicidal behavior and the pandemic outbreak are still controversial. Longitudinal analysis using validated suicide scales and multicenter studies could provide deeper insight and knowledge about this topic.
Bevilacqua, M.L. (2023). Educator’s views on suicide prevention in high schools and what they need. The Journal of Medicine Access. 7 1– 7. DOI:10.1177/27550834231158188
A qualitative study of high school educators and their perceptions toward current suicide prevention, including what is lacking.
Abstract – Background: Suicide is the leading cause of death among youth. Although school-aged youth are surrounded by educators and professionals, little is known about what educators want to know regarding suicide. Objective and design: The purpose of this qualitative study was to explore the perceived learning needs of high school educators in Northwestern Ontario (NOW) regarding suicide prevention using semi-structured interviews. Results: The results yielded educators prefer learning based on a mixture of styles that is relevant to their student needs; noting that time constraints are a barrier. Educators are interested in knowing what to say; however, limited by the unknown legalities involved. Educators expressed being comfortable talking about suicide and understood basic warning signs. Conclusions: The findings can assist mental health professionals and school board administration in supporting educators regarding suicide prevention. Future research can include the creation of a suicide prevention program that is targeted exclusively for high school educators.
Cerulli, C. et al. (2023). A randomized control trial to test dissemination of an online suicide prevention training for intimate partner violence hotline workers. Journal of Family Violence. https://doi.org/10.1007/s10896-023-00533-7
There is a growing understanding of the intersection between intimate partner violence (IPV) and suicide. This is a study of an online suicide prevention training that was offered to responders at the National Domestic Violence Hotline.
Abstract – Purpose: Suicide risk is higher among violence-involved individuals. Intimate Partner Violence hotline workers are a critical source of support and can potentially be suicide prevention champions. Our primary goal was to examine the effectiveness of disseminating a free, online IPV—Suicide Prevention curriculum, via a randomized control trial, to hotline workers in ten states with the highest suicide and IPV homicide rates. Method: We divided the country into five regions and, based on criterion, chose two states in each region to randomize into the two arms of the study. We examined training participation and engagement between the two approaches: (1) ‘dissemination as usual’ (control) using a National Domestic Violence Hotline email and a postcard to state/county IPV directors, versus (2) ‘enhanced dissemination’ (intervention) using a four-point touch method (postcard, phone call, email, and letter) to ‘drive’ participation. Results: Participation increased in the intervention arm as approaches became more personal (i.e., email and phone calls vs. letters). Results indicate that traditional dissemination strategies such as email announcements and invitations are not as effective as varied and multiple touchpoints for IPV hotline staff. Conclusion: Successful dissemination strategies to promote digital training should consider the value added by personalized connection. Future research is needed to understand how to offer effective and efficient web-based training to those providing IPV and child abuse services.
Giallo, R. et al. (2023). Preconception factors associated with postnatal mental health and suicidality among first‑time fathers: Results from an Australian Longitudinal Study of Men’s Health. Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-023-02421-3
This Australian study looked at the mental health difficulties and potential suicidal behaviours of first-time fathers in the first postnatal year.
Abstract – Purpose: Prospective evidence about men at risk of postnatal difficulties is rare–particularly for postpartum suicidal ideation. This study aimed to determine the extent to which first-time fathers reported depressive symptoms and suicidal ideation and behaviours in the first postnatal year, and to identify preconception risk factors for postnatal mental health difficulties. Methods: Secondary analysis of data from The Ten to Men Study–Australia’s population-based prospective study of men’s health was conducted. Participants were 205 men who became first-time fathers in the 12 months prior to wave 2 (2015/16). Regression analyses were used to ascertain preconception (mental and physical health, lifestyle) and demographic factors associated with postnatal depressive symptoms. Results: Postnatally, 8.3% of fathers reported moderate to severe depressive symptoms, 5% had suicidal thoughts, 3% had plans, and less than 1% had attempted suicide. Preconception depressive symptoms was the only factor significantly associated with postnatal depressive symptoms. Conclusion: The transition into fatherhood is marked with significant psychological distress for some men. These results suggest that mental health screening and support in the preconception period is crucial to supporting the mental health of new fathers.
Haregu, T. et al. (2023). The rate of transition to a suicide attempt among people with suicidal thoughts in the general population: A systematic review. Journal of Affective Disorders, 331, 57-63. https://doi.org/10.1016/j.jad.2023.03.063
This is a systematic review of 18 studies looking at the prevalence of people with suicidal ideation who transition to attempted suicide.
Abstract – Introduction: While suicidal thoughts are relatively common in the general population, roughly affecting one in ten people during their lifetime, the transition from suicidal thoughts to a suicide attempt is rarer. There is limited consensus on the transition rate from suicidal ideation to suicide attempts. Objective: To review and summarize evidence on the rate of transition from suicidal ideation to a suicide attempt, and the factors associated with this transition, in the general population. Methods: A comprehensive search was conducted using MEDLINE, PsycINFO, and Embase for relevant articles published between January 1, 2000, and March 3, 2021. We identified 18 eligible studies that examined the transition from suicidal ideation to a suicide attempt in non-clinical populations. We assessed the quality of the included studies using the MASTER scale. The review has been registered with PROSPERO (CRD42021248325). Results: Rates of transitioning to a suicide attempt among people with suicidal ideation varied substantially across studies, from 2.6 % to 37 %. Follow-up periods also varied substantially, from 12 to 300 months, impeding reliable comparisons across studies or pooling data for further analyses. The most examined risk factors were mental health disorders such as major depressive and anxiety disorders, which were typically associated with higher odds of transition to a suicide attempt. Limitations: High level of heterogeneity and limited quality of the studies. Conclusion: The risk of transition from suicidal thoughts to a suicide attempt is moderate to high. Further longitudinal research is required to refine the rate and explore social determinants of transition from suicidal ideation to suicide attempts.
Hwang, I. et al. (2023). New COVID-19 challenges and response strategies adopted by a national suicide prevention hotline: A qualitative study. Death Studies. https://doi.org/10.1080/07481187.2023.2186535
Responders on Taiwan’s national suicide prevention hotline service were interviewed about the challenges and responses they experienced during the COVID-19 pandemic.
Abstract – Crisis helplines provide important support for vulnerable individuals during the COVID-19 pandemic, which may also impact the helplines. We explored the challenges that the pandemic brought to Taiwan’s national suicide prevention hotline and the hotline’s responses. We interviewed 14 hotline workers and conducted data analysis using the framework method. The pandemic posed two new challenges to the hotline: potential service interruption and the adjustment of perceived role among hotline workers. The hotline’s well-formulated response plan helped it sustain its services during the pandemic, although the workers also experienced stress and frustration resulted from role ambiguity. Our data highlighted the hotline workers’ need for accurate COVID-19 information, relevant training, and timely support.
🇨🇦 Madigan, S. et al. (2023). Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: A systematic review and meta-analysis. Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(23)00036-6
This is a systematic review of 42 studies concerning children and adolescent hospital emergency visits for suicidal behaviours before and during the COVID-19 pandemic.
Abstract – Background: There is a lack of consensus about the effect of the COVID-19 pandemic on the mental health of children and adolescents. We aimed to compare rates of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation during the pandemic with those before the pandemic. Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO for studies published between Jan 1, 2020, and Dec 19, 2022. Studies published in English with data on paediatric (ie, those aged <19 years) emergency department visits before and during the COVID-19 pandemic were included. Case studies and qualitative analyses were excluded. Changes in attempted suicide, self-harm, suicidal ideation, and other mental-illness indicators (eg, anxiety, depression, and psychosis) were expressed as ratios of the rates of emergency department visits during the pandemic compared with those before the pandemic, and we analysed these with a random-effects meta-analysis. This study was registered with PROSPERO, CRD42022341897. Findings: 10 360 non-duplicate records were retrieved, which yielded 42 relevant studies (with 130 sample-estimates) representing 11·1 million emergency department visits for all indications of children and adolescents across 18 countries. The mean age of the samples of children and adolescents across studies was 11·7 years (SD 3·1, range 5·5–16·3), and there were on average 57·6% girls and 43·4% boys as a proportion of emergency department visits for any health reasons (ie, physical and mental). Only one study had data related to race or ethnicity. There was good evidence of an increase in emergency department visits for attempted suicide during the pandemic (rate ratio 1·22, 90% CI 1·08–1·37), modest evidence of an increase in emergency department visits for suicidal ideation (1·08, 0·93–1·25), and good evidence for only a slight change in self-harm (0·96, 0·89–1·04). Rates of emergency department visits for other mental-illness indications showed very good evidence of a decline (0·81, 0·74–0·89), and paediatric visits for all health indications showed strong evidence of a reduction (0·68, 0·62–0·75). When rates for attempted suicide and suicidal ideation were combined as a single measure, there was good evidence of an increase in emergency department visits among girls (1·39, 1·04–1·88) and only modest evidence of an increase among boys (1·06, 0·92–1·24). Self-harm among older children (mean age 16·3 years, range 13·0–16·3) showed good evidence of an increase (1·18, 1·00–1·39), but among younger children (mean age 9·0 years, range 5·5–12·0) there was modest evidence of a decrease (0·85, 0·70–1·05). Interpretation: The integration of mental health support within community health and the education system—including promotion, prevention, early intervention, and treatment—is urgently needed to increase the reach of mental health support that can mitigate child and adolescent mental distress. In future pandemics, increased resourcing in some emergency department settings would help to address their expected increase in visits for acute mental distress among children and adolescents.
Roach, P. et al. (2023). Prevalence and characteristics of anti-Indigenous bias among Albertan physicians: A cross-sectional survey and framework analysis. BMJ Open. http://dx.doi.org/10.1136/bmjopen-2022-063178
This is an analysis of a survey of Alberta physicians measuring anti-Indigenous bias. The survey was distributed in September 2020 to all practicing physicians with an active medical licence in Alberta and 375 physicians responded.
Abstract – Objective: Recent deaths of Indigenous patients in the Canadian healthcare system have been attributed to structural and interpersonal racism. Experiences of interpersonal racism by Indigenous physicians and patients have been well characterised, but the source of this interpersonal bias has not been as well studied. The aim of this study was to describe the prevalence of explicit and implicit interpersonal anti-Indigenous biases among Albertan physicians. Design and setting: This cross-sectional survey measuring demographic information and explicit and implicit anti-Indigenous biases was distributed in September 2020 to all practising physicians in Alberta, Canada. Participants: 375 practising physicians with an active medical licence. Outcomes: Explicit anti-Indigenous bias, measured by two feeling thermometer methods: participants slid an indicator on a thermometer to indicate their preference for white people (full preference is scored 100) or Indigenous people (full preference, 0), and then participants indicated how favourably they felt toward Indigenous people (100, maximally favourable; 0, maximally unfavourable). Implicit bias was measured using an Indigenous-European implicit association test (negative scores suggest preference for European (white) faces). Kruskal-Wallis and Wilcoxon rank-sum tests were used to compare bias across physician demographics, including intersectional identities of race and gender identity. Main results: Most of the 375 participants were white cisgender women (40.3%; n=151). The median age of participants was 46–50 years. 8.3% of participants felt unfavourably toward Indigenous people (n=32 of 375) and 25.0% preferred white people to Indigenous people (n=32 of 128). Median scores did not differ by gender identity, race or intersectional identities. White cisgender men physicians had the greatest implicit preferences compared with other groups (−0.59 (IQR −0.86 to –0.25); n=53; p<0.001). Free-text responses discussed ‘reverse racism’ and expressed discomfort with survey questions addressing bias and racism. Conclusions: Explicit anti-Indigenous bias was present among Albertan physicians. Concerns about ‘reverse racism’ targeting white people and discomfort discussing racism may act as barriers to addressing these biases. About two-thirds of respondents had implicit anti-Indigenous bias. These results corroborate the validity of patient reports of anti-Indigenous bias in healthcare and emphasise the need for effective intervention.
Seideler. I. et al. (2023). Time trends and geographical patterns in suicide among Greenland Inuit. BMC Psychiatry. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-04675-2
In the last forty years, Greenland has experienced some of the highest rates of suicide in the world. This contrasts sharply to be the earlier period of 1901-1960, where suicides were rare events. This study looks at suicide rates “according to age, birth cohort, period, sex, place of residence and suicide method from 1970 until 2018”.
Abstract – Background: Between 1980 and 2018 Greenland has had one of the highest suicide rates in the world with an average rate of 96 suicides per 100,000 people annually. The aim of this study is to investigate suicide rates in Greenland according to age, birth cohort, period, sex, place of residence and suicide method from 1970 until 2018. Methods: Suicide rates were examined using register and census data from 1970–2018 among Greenland Inuit. Rates were calculated by Poisson regression in Stata and by use of Excel. In analyses of the period trends, rates were standardized according to the World Standard Population 2000–2025. Results: The suicide rate has been declining since a peak at 120 suicides per 100,000 people annually in the 1980s but remained high at a rate of 81.3 suicides per 100,000 people annually from 2015–2018. Descriptive analyses point to the decrease in male suicides as the primary factor for the overall decreasing rates while the rate among women has been increasing. Simultaneously, the proportion of women who used a violent suicide method increased from 60% in 1970–1979 to 90% in 2010–2018. The highest rates are seen among young people, especially young men aged 20–24 years and youth suicide rates increased with later birth cohorts. When the rates started to increase in the 1980s both the capital Nuuk and East Greenland had the highest rates. Since then, the rate in Nuuk has declined while the rate in East Greenland was three times the national rate from 2015–2018. Conclusions: From 1970 to 1989 the suicide rate increased from 28.7 to 120.5 per 100,000 people mirroring a rapid societal transition in the post-colonial period. The rate has slowly declined from the peak in the 1980s but remains at a very high level. Young people in general are at risk, but the steady increase in the rate among women is worrying and there is a need to investigate underlying causes for this development.
🇨🇦 Sun, Y. et al. (2023). Comparison of mental health symptoms before and during the covid-19 pandemic: Evidence from a systematic review and meta-analysis of 134 cohorts. BMJ. https://doi.org/10 .1136/bmj-2022-074224
A systematic review of studies comparing general mental health, anxiety symptoms, and depression symptoms in the general population before the COVID-19 pandemic and then during the pandemic.
Abstract – Objective: To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic. Design: Systematic review. Data sources: Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints. Eligibility criteria for selecting studies Studies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies. Results: As of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval −0.00 to 0.22) or anxiety symptoms (0.05, −0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses. Conclusions: High risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health).
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