Research Roundup – March 2024
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month.
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Small, L.A. et al. (2024). Gender-based violence and suicide among gender-diverse populations in the United States. Archives of Suicide Research, 28(1), 107–122.
https://doi.org/10.1080/13811118.2022.2136023
Gender-diverse populations are analyzed, using information from the United States Transgender Survey, to gauge the relationship between gender-based violence and suicide.
Abstract – Objectives: Transgender populations report higher suicidal ideation (SI) and suicide attempts than the general population. This study sought to identify predictors of suicide in individuals with diverse gender identities, including transgender women; transgender men; and gender-nonbinary, genderqueer, and crossdressing individuals within various racial/ethnic groups. Methods: Secondary analyses were conducted using the United States Transgender Survey (N = 27,204). The dependent variables were SI and suicide attempts in the past 12 months. The independent variables were gender, race, employment status, transactional sex, exposure to violence, and age. Bivariate, multivariable, and nested models were used to examine the association between variables. Results: Findings reveal transgender women to be more likely to report SI than other gender groups. White and Hispanic/Latino participants were more likely to have SI than Black participants. Transgender men and gender-nonbinary groups were significantly less likely to attempt suicide than transgender women, and crossdressers were not significantly different in suicide attempts than transgender women. Increased exposure to violence was associated with increased SI and suicide attempts. Increased age and part- or full-time employment were associated with decreased SI and suicide attempts. White transgender women were more likely to have attempted suicide than white transgender men and gender-nonbinary groups. Asian and biracial transgender women were more likely to have attempted suicide than the other gender groups. Conclusions: Findings illuminate differences in suicide among individuals with diverse racial and gender identities and support the call for continued research on mental health experiences of these populations.
Krysinska, K. et al. (2024). Evaluation of a new online program for children bereaved by suicide: The view of children, parents, and facilitators. Archives of Suicide Research. 28(1), 384–398.
https://doi.org/10.1080/13811118.2023.2185559
Young participants, parents, and facilitators were interviewed about an online suicide postvention program for children bereaved by suicide called Let’s talk suicide.
Abstract – Objective: Experiencing the suicide of a parent or a sibling is one of the most disruptive and stressful events in the life of a child or adolescent. Yet, little is known about the effectiveness of support offered to children and adolescents bereaved by suicide. This study aimed to evaluate participant and facilitator’s perceived helpfulness of the new online Let’s Talk Suicide program, piloted in 2021. Method: Thematic Analysis of qualitative interviews with 4 children, 7 parents, and 3 facilitators (N = 14). Results: The analysis identified four themes focused on suicide bereavement specific support, the online environment experiences, expectations and perceived outcomes of the program, and parents’ involvement in the program. Conclusions: The young participants, parents, and facilitators were very positive about the program. They felt that it supported the children in their grief after suicide, helped to normalize their experiences, offered social support from peers and professionals, and enhanced their language and skills to express themselves and to deal with their emotions. Though longitudinal research is needed, the new program seems to address an existing gap in postvention services for children and adolescents bereaved by suicide.
Ki, M. et al. (2024). A systematic review of psychosocial protective factors against suicide and suicidality among older adults. International Psychogeriatrics.
https://doi.org/10.1017/S104161022300443X
In this study, a systematic review of 70 studies looking at protective factors for suicide among older adults was undertaken.
Abstract – Background: Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults. Method: First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis. Results: A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures. Conclusion: Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.
Montiel, C. & Mishara, B.L. (2024). Evaluation of the outcomes of the Quebec provincial suicide prevention gatekeeper training on knowledge, recognition of attitudes, perceived self-efficacy, intention to help, and helping behaviors. Suicide and Life-Threatening Behavior, 54(1), 108-121.
https://doi.org/10.1111/sltb.13022
The Quebec Gatekeeper Training Program was evaluated for knowledge, recognition of attitudes, perceived self-efficacy, intention to help, and helping behaviors.159 participants were surveyed at pre-test, post-test and 6-month follow-up intervals.
Abstract – Introduction: Gatekeeper (GK) training is a suicide prevention strategy in which community members learn to identify individuals at risk of suicide and refer them for appropriate help. Despite its widespread use, few studies have investigated its effects, including changes in helping behaviors.
Aims: To assess the impact of GK training on participants’ knowledge, recognition of the influence of attitudes, perceived self-efficacy, intention to help and helping behaviors, and to identify variables associated with GK behaviors. Methods: Mixed linear effects and forward stepwise logistic regressions were used to analyze data from 159 participants receiving the Quebec Provincial GK Training program offered by five different suicide prevention centers using pretest, posttest and 6-month follow-up questionnaires. Results: Participants’ knowledge of the GK role and suicide prevention, intention to help, self-efficacy, knowledge of services, and recognition of the influence of attitudes significantly increased following training. Most changes decreased at follow-up but remained higher than at pretest. Lower levels of education and higher intention to help were significant predictors of engaging in helping behaviors in the first 6 months after receiving training. Conclusions: The Quebec GK training appears to be effective in preparing participants for their role but does not appear to significantly increase helping behaviors.
Hamstra-Wright, K.L. et al. (2024). Preventing suicide and promoting mental health among student-athletes from diverse backgrounds. Journal of Sport Rehabilitation.
https://doi.org/10.1123/jsr.2023-0085
The risk of suicide among post-secondary student-athletes in the United States is examined. Sociodemographic factors, the role of injury, and other components are considered.
Abstract – Suicide and contributing mental health conditions in athletes are shared concerns within health care and society at large. This commentary focuses on suicide risk among athletes and the role of sports medicine professionals in preventing suicide and promoting mental health. In this commentary, we draw on the scientific literature and our clinical experiences to pose and answer these questions: Does suicide risk among athletes vary by sociodemographic factors (eg, sex, gender, race/ethnicity, family income, sexual orientation) or if injured? Do sociodemographic differences influence access to and benefits from services among athletes? How do I know my athletes are at risk for suicide? What do I do if one of my athletes shares with me that they have considered suicide? Within our commentary, we review the current literature and clinical practices regarding these questions and close with actionable suggestions and recommendations for future directions.
Mickelson, J.M. et al. (2024). A distress-processing model for clients in suicidal crisis: Development and initial validation. Crisis, 45(1), 18–25.
https://doi.org/10.1027/0227-5910/a000907
This is a study in two parts. The first is the development of a sequential distress-processing model for clients in suicidal crisis. The second is the validation of the model.
Abstract – Background: While crisis intervention frameworks have indicated the importance of clients in suicidal crisis better understanding their distress to decrease suicidality, it is unclear how clients in suicidal crisis process their distress. Aims: To develop (Study 1) and validate (Study 2) a sequential distress-processing model for clients in suicidal crisis. Methods: Applying task analysis, Study 1 consisted of three phases, which resulted in a theoretically and empirically informed model. In Study 2, we examined the distress-processing model’s validity using a longitudinal design. In both studies, data were online crisis chats with adults in suicidal crisis. Results: In Study 1, we developed a sequential five-stage distress-processing model: (Stage 1) unengaged with distress, (Stage 2) distress awareness, (Stage 3) distress clarity, (Stage 4) distress insight, and (Stage 5) applying distress insight. In Study 2, the model’s validity was supported via evidence that (H1) progression through the processing stages was sequential and (H2) clients with good outcomes had greater progression in their processing than clients with poor outcomes. Limitation: Clients who were suicidal but did not disclose their suicidality were not included. Conclusion: Our findings provide a framework for conceptualizing and operationalizing how clients move through suicidal crises, which can facilitate intervention and research developments.
Sinyor, M. et al. (2024). The Kenneth Law media event: A dangerous natural experiment. Crisis. 45(1), 1–7.
https://doi.org/10.1027/0227-5910/a000942
This editorial discusses the Kenneth Law case. The authors believe media coverage of the story was delivered in dangerous ways. They explain why the reportage was dangerous and suggest how it could have been reported more safely.
Abstract – In late April 2023, the international media broke the story of the arrest and criminal charges against Kenneth Law, a Canadian man accused of sending a deadly substance to a number of individuals across Canada and internationally (Miller, 2023; Peel Regional Police, 2023). This is a newsworthy story and one that deserves coverage. However, it also carries the potential for harm, as the substance Law allegedly distributed is unusual and previously unknown to most of the public. In this editorial, we will describe some of the ethical issues and considerations regarding responsible reporting of the Kenneth Law story and make recommendations about how such information might be conveyed more safely to the public going forward. At the outset, we acknowledge two important points. First, at the time of writing, Mr. Law’s criminal case is still before the courts. Second, the decision of many journalists reporting on the case to name the actual substance was not in alignment with responsible media reporting guidelines and we ask that expert colleague readers, as well as any journalists who may come across this article, not name it or any other novel suicide method in public-facing communications.
Tyler, S. et al. (2024). Disentangling rates, risk, and drivers of suicide in the construction industry: A systematic review. Crisis. 45(1), 74–83.
https://doi.org/10.1027/0227-5910/a000885
This review looks at 16 studies of suicide in the construction industry. 25 “drivers”, or contributing factors, of suicide in the industry were isolated and analyzed.
Abstract – Background: Research suggests construction industry workers (CIWs) face increased suicide vulnerability. Aims: The current study synthesizes international evidence examining rates, risk, and drivers of CIW suicide. Method: Comprehensive searches of MEDLINE, PsycInfo, Embase, Emcare, Web of Science, Scopus, and gray literature were undertaken, identifying studies that discussed, theorized about, or demonstrated risks and/or rates and/or drivers of CIW suicide, without inclusion of other industries. Results: A number of included studies statistically analyzed suicide outcomes in a variety of CIW populations, with the majority reporting increased rate and/or risk, however significant heterogeneity limited comparisons. Twenty-five potential drivers were identified and classified as personal- or industry-related. Disentanglement highlighted the relevance of previously understood personal drivers, need for future focus on industry drivers, and potential interplay between drivers. Limitations: Exclusion of non-English articles as well as inability to extend analysis to fully understand rates and/or risk of CIW suicide and tenuous links between suggested drivers and suicide outcomes. Conclusion: Despite limitations, this paper aids understanding in relation to the suggestion that CIWs are at increased suicide vulnerability. Disentanglement of potential drivers demonstrates the importance of future research focused on industry drivers to assist in prevention strategies.
Pepper et al. (2024). A cultural script for suicide among White men in the Mountain West Region of the United States. American Psychologist.
https://doi.org/10.1037/amp0001311
The states in the Mountain West Region of the United States have the highest rates of suicide in the country. This review looks at several studies identifying specific factors which contribute to these high rates.
Abstract – The states of the Mountain West region of the United States consistently have the highest rates of suicide in the country, a pattern particularly pronounced in older White men. Although multiple constructs have been proposed to explain this long-standing pattern, including social isolation, cultural values, and psychopathology, relatively little research has been conducted to directly examine the predictive role of these risk factors and how they interact. We review the extant research for these constructs to establish (a) whether the risk factor occurs at a higher rate or is otherwise more influential in this region compared to the rest of the country and (b) whether the risk factor may account for specific effects in older White men in order to determine whether the evidence supports the role of each risk factor in understanding the high rates of suicide among older White men in this region. Using the results of this review, we then present a possible cultural script for suicide based on cultural scripts of gender and suicide theory (Canetto, 1997, 2017, 2021) that describes who dies by suicide, the methods they use, their emotions and motives, and the cultural understanding of the causes and acceptability of their suicidal behaviors within the Mountain West. This cultural script can serve as a guide for researchers investigating the complex mechanisms that account for elevated rates of suicide in this region.
Grimland, M. et al. (2023). Predicting suicide risk in real-time crisis hotline chats integrating machine learning with psychological factors: Exploring the black box. Suicide and Life-Threatening Behavior. https://doi.org/10.1111/sltb.13056
A dataset of crisis line chat sessions was analyzed using a machine-learning (ML) model, which incorporated a suicide risk factors-based lexicon (SRF) (based on suicide theory). The authors aimed to determine whether this combination of ML models and suicide theory can improve suicide risk prediction.
Abstract – Background: This study addresses the suicide risk predicting challenge by exploring the predictive ability of machine learning (ML) models integrated with theory-driven psychological risk factors in real-time crisis hotline chats. More importantly, we aimed to understand the specific theory-driven factors contributing to the ML prediction of suicide risk. Method: The dataset consisted of 17,654 crisis hotline chat sessions classified dichotomously as suicidal or not. We created a suicide risk factors-based lexicon (SRF), which encompasses language representations of key risk factors derived from the main suicide theories. The ML model (Suicide Risk-Bert; SR-BERT) was trained using natural language processing techniques incorporating the SRF lexicon. Results: The results showed that SR-BERT outperformed the other models. Logistic regression analysis identified several theory-driven risk factors significantly associated with suicide risk, the prominent ones were hopelessness, history of suicide, self-harm, and thwarted belongingness. Limitations: The lexicon is limited in its ability to fully encompass all theoretical concepts related to suicide risk, nor to all the language expressions of each concept. The classification of chats was determined by trained but non-professionals in metal health. Conclusion: This study highlights the potential of how ML models combined with theory-driven knowledge can improve suicide risk prediction. Our study underscores the importance of hopelessness and thwarted belongingness in suicide risk and thus their role in suicide prevention and intervention.
Sinyor et al. (2024). The development, progress, and impact of national suicide prevention strategies worldwide. Crisis.
https://doi.org/10.1027/0227-5910/a000948
This is a commentary advocating for national suicide prevention strategies. The “article reviews the rationale for national strategies, the need for a whole-of-government approach, and current progress on national strategies worldwide, including successes and challenges regarding implementation”.
Abstract – National suicide prevention strategies have been identified as evidence-informed interventions that require multisectoral efforts by governments. This article reviews the rationale for national strategies, the need for a whole-of-government approach, and current progress on national strategies worldwide, including successes and challenges regarding implementation. We highlight the limitations of existing evidence and describe how future research may help to address knowledge gaps. We conclude that national strategies are an important tool for suicide prevention worldwide. However, a more robust evidence base evaluating the impact of strategies on suicide-related outcomes is needed.
Loitz et al. (2024). Evaluation of a community helpers’ mental health and suicide awareness training programme for youth and young adults in Alberta, Canada. Public Health.
https://doi.org/10.1016/j.puhe.2024.01.009
This is an evaluation of a suicide prevention and awareness program called Community Helpers Programme (CHP). It was developed to train community helpers to support youth and young adults to problem solve and seek mental health support. It was evaluated for knowledge, self-efficacy, and awareness of stigma.
Abstract – Objective: The Community Helpers Programme (CHP) is a peer-helping programme providing youth and young adults with tools to support their peers to problem solve and seek mental health and suicide prevention support. This study aims to evaluate the effectiveness of the provincial programme (primary outcomes = knowledge, self-efficacy; secondary outcome = awareness of stigma) and describe the experience of participants, coordinators, and others. Study design: The mixed methods evaluation included a longitudinal panel design outcome evaluation along with follow-up interviews. Methods: A series of three surveys collecting participant characteristics, knowledge, self-efficacy, and awareness of stigma at pre-training (T0), post-training (T1), and six-months follow-up (T2) were conducted. Mean group scores were calculated for completers (T0 and T1 completers and T0, T1, and T2 completers). Friedman tests were conducted to assess change over time and follow-up Wilcoxon Signed Rank tests determined the significance of changes in scores between each timepoint. Content analysis was conducted on qualitative data. Results: Participants’ knowledge of mental health, suicide, and available supports along with self-efficacy increased from T0 to T1, and declined at T2. Awareness of stigma was high at all timepoints. Themes from the qualitative analysis included skill and knowledge development facilitators (e.g., consideration of learner needs, passionate coordinators, engaged learning approaches), sustaining community helper connectedness (e.g., helpers’ network, awareness of and communication with local resources), and role and impact of CHP (e.g., addressing stigma, success stories). Conclusions: This evaluation demonstrated that CHP was effective and offered feedback on experiences, including suggestions on CHP strengths and aspects to explore.