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

Ralfman, et al. (2020). Suicide fatalities in the US compared to Canada: Potential suicides averted with lower firearm ownership in the US. PLOS One. 15(4): e0232252. DOI:
Means restriction is a best practice in suicide prevention. Firearms are a very lethal method of suicide. This report looks at the comparison of firearm suicides in the United States and Canada.

Abstract: Introduction and objective – The United States (US) has the highest rate of firearm suicides in the world. The US and Canada are comparable countries with markedly different rates of firearm ownership, providing an opportunity to estimate suicide fatalities that could be averted in the US with a lower rate of firearm ownership. Methods – We compared 2016 US suicide fatality rates–standardized within fourteen sex-specific age groups to reflect the ethnic composition of Canada–to 2016 Canadian suicide rates. We then calculated the number and proportion of suicides that could be averted in the US if the US had the same rates of suicide as in Canada. Results – If the US had the same suicide rates as in Canada, we estimate there would be approximately 25.9% fewer US suicide fatalities, equivalent to 11,630 suicide fatalities averted each year. This decline would be driven by a 79.3% lower rate of firearm-specific suicide fatalities. The male suicide fatality rate would be 28.8% lower and equivalent to 9,992 fewer suicide fatalities each year. The female suicide fatality rate would be 16.0% lower and equivalent to 1,638 fewer suicide fatalities each year. While 36% of firearm suicide fatalities could be replaced by non-firearm suicide fatalities, 64% of firearm fatalities could be averted entirely. Conclusions – US policymakers may wish to consider policies that would reduce rates of firearm ownership, given that that about 26% of US suicide fatalities might be averted if the US had the same suicide rates as in Canada, a country with drastically lower firearm ownership rates.

(🇨🇦)  McIntyre, R.S. & Lee, Y. (2020). Projected increases in suicide in Canada as a consequence of COVID-19. Psychiatry Research. DOI:
The COVID-19 pandemic and the accompanying economic devastation are expected to have large-scale detrimental effects on overall mental health. Three different scenarios project an increase in suicide depending on the increase in unemployment. 

Abstract: Macroeconomic indicators, notably unemployment, are significant moderators of suicide. We projected the number of excess suicides in Canada as a consequence of the impact of COVID-19 on unemployment. Annual suicide mortality (2000-2018) and unemployment (2000-2019) data were derived from Statistics Canada. Time-trend regression models were used to evaluate and predict the number of excess suicides in 2020 and 2021 for two possible projection scenarios following the COVID-19 pandemic: 1) an increase in unemployment of 1.6% in 2020, 1.2% in 2021, or 2) an increase in unemployment of 10.7% in 2020, 8.9% in 2021. A percentage point increase in unemployment was associated with a 1.0% increase in suicide between 2000-2018. In the first scenario, the rise in unemployment rates resulted in a projected total of 418 excess suicides in 2020-2021 (suicide rate per 100,000: 11.6 in 2020). In the second scenario, the projected suicide rates per 100,000 increased to 14.0 in 2020 and 13.6 in 2021, resulting in 2,114 excess suicides in 2020-2021. These results indicate that suicide prevention in the context of COVID-19-related unemployment is a critical priority. Furthermore, timely access to mental healthcare, financial provisions and social/labour support programs, as well as optimal treatment for mental disorders is urgently needed.

Horowitz, et al. (2020). Primary and secondary prevention of youth suicide. Pediatrics. DOI:
A paper advocating for a greater involvement of pediatricians in the prevention of youth suicide, involving universal screening and the development of safety planning. Pediatricians are “uniquely positioned” to intervene if given the proper education and training in suicide prevention.

Abstract: Youth suicide is a national and global public health crisis. Pediatricians can use primary and abstract secondary prevention strategies to intervene with youth before or after the onset of suicidal behaviors. Universal suicide risk screening programs can be used to identify youth in medical settings who may otherwise pass through the health care setting with undetected suicide risk.Pediatricians are uniquely positioned to help foster resilience in their young patients and equip families of at-risk youth with safety plans and lethal means safety counseling. Pediatricians on the frontlines of this critical public health crisis require education and training in detecting suicide risk, managing those who screen positive, and connecting their patients to much needed mental health interventions and treatments. Evidence-based suicide risk screening and assessment tools, paired with interventions, are feasible and potentially life-saving in the medical setting.

Thorn, P., et al. (2020). Developing a suicide prevention social media campaign with young people (The #Chatsafe Project): Co-design approach. Journal of Medical Internet Research, 7(5). DOI: 10.2196/17520
This study looked at developing a social media campaign for suicide prevention. The input of young people was incorporated into the ultimate design of the project.

Abstract: Background – Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions. Objective – This study aimed to document key elements of the co-design process; to evaluate young people’s experiences of the co-design process; and to capture young people’s recommendations for the #chatsafe suicide prevention social media campaign. Methods – In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people’s experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators. Results – The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services. Conclusions – This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web.

Grande, et al. (2020). Mental health interventions for suicide prevention among indigenous adolescents: a systematic review protocol. BMJ Open. DOI: 10.1136/bmjopen-2019-034055
A protocol proposal for a systematic review of suicide prevention initiatives worldwide that focus on Indigenous adolescents.

Abstract: Introduction – There are more than 370million indigenous people from 5000 cultures living in 90 countries worldwide. Although they make up 5% of the global population, they account for 15% of the extreme poor. Youth suicide is the second leading cause of mortality among 15–29 years old and disproportionately affects indigenous youth. This research protocol pertains to a systematic review of studies that use a comparator/control group to evaluate the effectiveness of suicide interventions targeting indigenous adolescents (aged 10–19 years). Methods and analysis We will conduct a systematic search on MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO from inception to September 2019 to identify articles that compare mental health interventions for suicide prevention among indigenous adolescents. Two reviewers will independently determine the eligibility of each study. Studies will be assessed for methodological quality using the risk of bias tool to assess nonrandomised studies of interventions. We will conduct a meta-analysis if possible and use established statistical methods to identify and control for heterogeneity where appropriate.

Reger, M., Stanley, I. & Joiner, T. (2020). Suicide mortality and coronavirus disease 2019—a perfect storm?JAMA Psychiatry. DOI: 10.3389/fpsyg.2017.01756
A commentary by leading voices in American suicidology opining that public health priorities during the COVID-19 pandemic should include actions involving mental health and suicide prevention, alongside social distancing measures and other COVID-19 prevention efforts.

Abstract: Suicide rates have been rising in the US over the last 2 decades. The latest data available (2018) show the highest age-adjusted suicide rate in the US since 1941.1 It is within this context that coronavirus disease 2019 (COVID-19) struck the US. Concerning disease models have led to historic and unprecedented public health actions to curb the spread of the virus. Remarkable social distancing interventions have been implemented to fundamentally reduce human contact. While these steps are expected to reduce the rate of new infections, the potential for adverse outcomes on suicide risk is high. Actions could be taken to mitigate potential unintended consequences on suicide prevention efforts, which also represent a national public health priority.

Brietzke, E. (2020). Three insights on psychoneuroimmunology of mood disorders to be taken from the COVID-19 pandemic. Brain, Behavior & Immunity, 5. DOI:
A commentary stating that the COVID-19 pandemic may offer unprecedented opportunity to study the relationship of respiratory viruses with mood disorders and suicide.

Abstract: It is well known that depression and some domains of depressive psychopathology such as anhedonia and suicidal behavior exhibit seasonal variation. Factors that may be implicated in this association include variations in light exposure and the incidence of viral infections, such as influenza. Replicated data from ecological studies show a seasonal peak of suicide in the spring (Postolache et al., 2010), which is even more pronounced in individuals with a history of mood disorders. It is also largely recognized the existence of an overlap between the peak of viral respiratory infections and the suicide rates, but methodological caveats prevent definitive cause-effect conclusions. In recent months, the world was taken by surprise by the outbreak of a coronavirus (SARS-CoV-2) pandemic (COVID-19). Coronaviruses have been recognized as a respiratory and neurotropic virus with the ability to penetrate the Central Nervous System (CNS) via the olfactory neural pathway. Viral infections may be associated with psychiatric symptoms as a direct result of the virus infection in the brain but most often due to activation of a powerful immune-inflammatory response (Cheng et al., 2004). Coronavirus infection has recently been implicated in the onset of psychosis (Severance et al., 2011), major depression and bipolar disorder (Okusaga et al., 2011). However, the COVID-19 pandemic is a unique opportunity to advance the understanding of the association of neurotropic respiratory viruses with mood disorders and suicide. It is necessary not only because mood disorders are highly prevalent, but also because the use of anti-inflammatory interventions is a promising but still underexplored treatment strategy. In this point of view, we speculate about some few insights that the COVID-19 pandemic could potentially offer to the scientific community to be further fully explored.

(🇨🇦) Ferlatte, O., et al. (2020). It is time to mobilize suicide prevention for sexual and gender minorities in Canada. Canadian Journal of Public Health. DOI:
The results of “community leaders, health professionals, policymakers, and researchers” coming together to identify priorities for suicide prevention actions for the sexual and minority adult (SGMA) population.

Abstract: Suicide is a significant health issue among sexual and gender minority adults (SGMA); yet, there are no tailored suicide prevention programs for these marginalized populations in Canada. We hosted two world cafés with community leaders, health professionals, policymakers, and researchers to identify recommendations for mobilizing SGMA-focused suicide prevention programs. We identified five priorities: (1) make society safer for sexual and gender minorities; (2) decrease barriers to mental health services; (3) support community-driven and community-based interventions; (4) increase suicide knowledge and reduce stigma; (5) expand the knowledge base on SGMA suicide. In the absence of a national Canadian SGMA suicide prevention policy, these priorities provide a starting point in addressing SGMA suicide inequities by advancing SGMA-tailored interventions.

Solomon & Peterson. (2020). Religion and suicide: The consequences of a secular society. Sigma: Journal of Political and International Studies, 37(6). 
Religion is a long-acknowledged protective factor against suicide. The authors believe that this has been largely ignored or downplayed in the literature. They use social data sets in the United States to help support their claims.

Abstract: Introduction – In 2017, suicide rose to become the tenth leading cause of death for U.S. citizens (U.S. Department of Health and Human Services 2018a). In the twenty years preceding 2017, the suicide rate increased significantly across the country. Twentyfive states experienced at least a 30 percent increase in suicide rates, and some states like North Dakota saw increases of as much as 57 percent (U.S. Department of Health and Human Services 2018b). The significant upswing in suicide rates affects the well-being of every American, both directly and indirectly. Indeed, one of the strongest indicators of a person’s likelihood to attempt suicide is exposure to the suicide of people close to them in their social network (Niederkrotenthaler et al. 2012; Ramchand et al. 2015). Beginning in the 1960s, American policymakers started taking suicide prevention seriously. The Center for Studies of Suicide Prevention was established as part of the National Institute of Mental Health in 1966, and government intervention culminated with the unprecedented Surgeon General’s Call to Action to Prevent Suicide in 1999 (U.S. National Library of Medicine 2016; U.S. Public Health Service 1999). Subsequent legislation like the Garrett Lee Smith Memorial Act of 2004 and the Joshua Omvig Veterans Suicide Prevention Act of 2007 continue to combat suicide (Suicide Prevention Resource Center 2016). However, while these government programs focus on providing resources and support for Americans struggling with suicidal tendencies, our understanding of what motivates someone to end his or her life remains dangerously inadequate as suicide rates continue to increase unabated (Ross, Yakovlev, and Carson 2012).

Huang, J.X., et al. (2020). Relationship between Buddhist belief and suicide risk in Chinese persons undergoing methadone maintenance therapy for heroin dependence. Frontiers in Psychiatry.  DOI: 10.3389/fpsyt.2020.00414 
Another paper looking at the effects of religion on suicidal behaviours. In this study, Buddhist beliefs, as opposed to western religious ones, is the focus. The effect of these beliefs on suicide risk among those experiencing Opioid (Heroin) Use disorder is examined.

Abstract: Background – In western countries, there is a negative association between religious belief and suicide risk, while in China this association is positive. Nevertheless, few data are available on the association between one specific type of religion and suicide risk, which might be different from the overall positive religion-suicide association in China. This study examined the association between Buddhist belief and suicide risk in Chinese persons receiving methadone maintenance therapy (MMT) for heroin dependence. Methods – In total, 61 Buddhist believers and 425 age, gender, and clinic frequency-matched non-religious believers were selected from a sample of patients with heroin dependence treated in three MMT clinics in Wuhan, China. The suicidality module of the Chinese version of the Mini-international Neuropsychiatric Interview 5.0 was used to assess current suicide risk. Patients’ demographic and clinical characteristics were also collected. Multiple ordinary logistic regression was used to analyze the association between Buddhist belief and current suicide risk, controlling for the confounding effects of demographic and clinical factors. Results – In Chinese patients receiving MMT for heroin dependence, Buddhist believers had significantly higher levels of current suicide risk than non-religious believers (low: 45.9% vs. 24.7%, medium: 4.9% vs. 3.5%, high: 19.7% vs. 12.5%, P < 0.001). After adjusting for demographic and clinical covariates (including depressive symptoms), Buddhist belief was still significantly associated with an increase in the level of current suicide risk (OR: 2.98, P < 0.001). Conclusion: Buddhist belief is significantly associated with elevated current suicide risk in Chinese patients receiving MMT for heroin independence. In Chinese MMT clinics, patients with Buddhist belief may have a high current suicide risk and a timely psychiatric assessment and crisis intervention (when necessary) should be provided to these patients.

(🇨🇦) V.I.O. (2020). Coronavirus Disease 2019 Pandemic: Health System and Community Response to a Text Message (Text4Hope) Program Supporting Mental Health in Alberta. Commentary
A forthcoming study of a text message application and its impacts on the mental health of participating Albertans during the COVID-19 pandemic.

Abstract: In an effort to support the mental health of Albertans during the coronavirus disease 2019 (COVID-19) pandemic, Alberta Health Services launched a supportive text message (Text4Mood) program on March 23, 2020. The program was simultaneously approved for funding by the 6 regional health foundations and launched within 1 week of conception. Residents of Alberta can subscribe to the program by texting “COVID19HOPE” to a sort code number. Each subscriber receives free daily supportive text messages, for 3 months, crafted by a team of clinical psychologists, psychiatrists, mental health therapist, and mental health service users. Within 1 week of the launch of Text4Hope, 32 805 subscribers had signed up to the program, and there have been expressions of interests from other jurisdictions to implement a similar program to support the mental health of those in quarantine, isolation, or lockdown.

Rytterstr€om, P., (2020). Impact of suicide on health professionals in psychiatric care mental healthcare professionals’ perceptions of suicide during ongoing psychiatric care and its impacts on their continued care work. International Journal of Mental Health Nursing (2020). DOI: 10.1111/inm.12738 
A Swedish study looking at how the suicide of patients affects the mental health of health care professionals who have provided care for them.

Abstract: People who attempt suicide as well as those who actually take their own life often have communicated their suicidal thoughts and feelings to healthcare professionals in some form. Suicidality is one of the most challenging caring situations and the impacts of suicide care affect both the professional and personal lives of healthcare professionals. This study investigates how mental health professionals perceive suicide while providing psychiatric care and how this perception impacts their continued care work. This qualitative exploratory study includes 19 mental health professionals in psychiatry who had provided care for patients who had taken their own life. Analysis followed the principle of phenomenography. The findings reveal that these healthcare professionals experienced an internal conflict that affected them both personally and professionally. In response to these conflicts, the healthcare professionals developed strategies that involved a safety zone and increased vigilance. Those who were able to commute and balance a safe spot and learning to be more vigilant seem to have developed as a result of patient’s suicide. These findings have the potential to help establish a post-suicide caring process where healthcare professionals learn to make better suicide assessments, become more open to talking about death with patients, and develop a humbler approach to understanding a patient’s suicide.

Bailey, E., et al. (2020). Ethical issues and practical barriers in internet-based suicide prevention research: a review and investigator survey. BMC Medical Ethics (2020), 21:37. DOI: 10.1186/s12910-020-00479-1
As online suicide prevention research becomes more commonplace, ethical issues will also come increasingly to the fore. This is an investigation into this area, including a systematic review of the relevant literature and an online survey of invited researchers.

Abstract: Background – People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method: This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk of suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results: The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion: There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them (i.e., those who prefer anonymity). Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area.

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