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

Reen, J., Friday, A., & Orji, R. (2022). Saving life and keeping privacy: A study on mobile apps for suicide prevention and privacy policies. International Conference on Persuasive Technology. In Baghaei, N., Vassileva, J., Ali, R., Oyibo, K. (eds.), Persuasive Technology. Lecture Notes in Computer Science, vol 13213. Springer, Cham. DOI: 10.1007/978-3-030-98438-0_15
This is a review of mobile health apps for suicide prevention and their efficacy.

Abstract – Suicide is a severe public health issue that impacts the lives of many individuals. Mobile health applications (apps) open new possibilities for safety by daily self-monitoring of suicide-related symptoms, which can help with safety planning. These mobile apps can help health professionals and specialists by providing follow-up and care throughout the treatment of patients with suicidal intents. A rising variety of suicide prevention measures based on the usage of new technologies are being developed now. In this paper, we reviewed literature on suicide prevention and also reviewed apps on the Apple App Store (App Store) and the Google Play Store (Play Store) focusing on the persuasive strategies used and the importance given to the privacy of the user. Our findings show that while most apps operationalize persuasive strategies, there is a lack of research on how users’ privacy is managed. We also found a lack in adopting an evidence-based approach in preventing suicide. Based on our findings, we recommend designers adopt more evidence-based approaches in helping individuals who are struggling with suicide and use technology to enforce privacy and data protection. Also, developers of suicide mobile intervention should design more interactive apps rather than passive apps and apply a user-center design approach. From our analysis, we offer some design recommendations and propose a communication protocol to enforce privacy when sharing sensitive data for suicide apps.

Waitling, D., Preece, M., Hawgood, J., Bloomfield, S., Kõlves, K. (2022). Developing a post-discharge suicide prevention intervention for children and young people: a qualitative study of integrating the lived-experience of young people, their carers, and mental health clinicians. Child and Adolescent Psychiatry and Mental Health, 16, 24. DOI: 10.1186/s13034-022-00460-3
The authors aim to craft a suicide prevention intervention for children and young people after they have left hospital for suicidal or self-harming behaviours. They draw on the lived-experience of young people, their carers, and mental health clinicians.

Abstract – Background: Suicide in young people is a leading cause of death. Interventions that are reflexive, tailored, and developed in concert with this at-risk population are needed. This study aimed to integrate lived-experience into the design of a suicide prevention intervention delivered by phone to young people post-discharge from an emergency department (ED) for suicide risk or self-harm. Methods: Qualitative study was conducted at the Queensland Children’s Hospital, Brisbane Australia. Four focus groups with young people with lived-experience, parents or carers and ED mental health clinicals were conducted. In total 5 young people with lived-experience of suicidality (17–21 years, Mage = 19.20), 3 parents and carers with a lived-experience of caring for a young person with mental illness, and 10 ED mental health clinicians participated in focus groups. The first phase of qualitative analysis involved a phenomenological analysis and second phase included a deductive content analysis. The paper is following the Consolidated Criteria for Reporting Qualitative Research. Results: First phase, a phenomenological analysis identified three foundational themes to structure future follow-up phone interventions: a person-centred focus, the phone-call dynamic, and the phone-call purpose. Second phase, a deductive content analysis found that participants preferred an intervention that was structured, consistent, and finite. Moreover, an intervention that was authentic, able to facilitate and empower growing independence, and achievable of young people after an ED presentation was desired. Conclusions: Participants expressed their desire for a responsive, structured, and clearly focused phone call that would recognise the young person and parent/carer’s needs while providing tailored support to ease transition from the ED to available community and family led care.

🇨🇦 Howell, A., Cowan-Nelson, E., & Cobuz, V. (2022). Depicted immorality influences the perceived applicability of the phrase “committed suicide.” Crisis, 43(2), 135-141. DOI: 10.1027/0227-5910/a000767
A Canadian study measuring university undergraduate perceptions of the phrases “committed suicide” and “died by suicide”.

Abstract – Background: “Committed suicide” is often deemed less acceptable than alternative phrases, but such judgments vary widely across individuals. Aim: We tested whether the endorsement of statements containing “committed suicide” is greater when a suicide death is depicted as immoral. We also assessed the degree of immorality suggested by the free-standing phrases “committed suicide” and “died by suicide.” Method: Undergraduate participants (N = 154) read scenarios of a suicide depicted as immoral and one depicted more neutrally and judged the applicability of statements employing either “committed suicide” or “died by suicide” to each scenario. Participants next chose between the free-standing phrases “committed suicide” or “died by suicide” in terms of which connoted immorality and provided written justifications for their choices. Results: Participants judged “committed suicide” statements to be most applicable to the immoral-suicide scenario. A large majority of participants chose “committed suicide” over “died by suicide” as connoting immorality and participants’ justifications for this choice revealed several meaningful themes. Limitations: Our manipulation of immorality employed religious overtones and our participants were undergraduate students. Conclusions: Findings contribute to the empirical basis for concerns regarding the phrase “committed suicide,” with implications for stigma reduction and help-seeking.

Diamond, G., Boruchovitz, R., Nir-Gotlieb, O., Gat, I., Bar-Kalifa, E., Fitoussi, P.Y., & Katz, S. (2022). Attachment-based family therapy for sexual and  gender minority young adults and their nonaccepting parents. Family Process. DOI: 10.1111/famp.12770
This is a pilot study of a targeted therapy for Sexual and Gender Minority young adults and their families.

Abstract – This pilot open trial examined the efficacy of attachment-based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults’ attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post-treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers’ acceptance of their young adult’s same-sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents’ levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT-SGM, a manualized, affirmative, experiential, family-based treatment, may be effective in reducing long-standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults’ relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.

Skopp, N., Smolenski, D., Bush, N., Beech, E., Workman, D., Edwards-Stewart, A., & Belsher, B. (2022). Caring contacts for suicide prevention: A systematic review and meta-analysis. Psychological Services.
A review of studies concerning a suicide intervention called Caring Contacts, long considered an efficacious strategy in the prevention of suicidal deaths.

Abstract – Caring Contacts (CC), a low-cost intervention originally designed and tested by Jerome Motto in 1976, remains one of the few strategies to demonstrate efficacy in the prevention of suicide deaths. Interest in CC has increased steadily over the last several years in tandem with rising U.S. suicide rates and the acceleration of suicide prevention initiatives. There have been several efforts to design interventions modeled after Motto’s strategy, and the recent publication of additional large-scale randomized controlled trials (RCTs) in alignment with the intent of Motto’s original model afford an opportunity to systematically review efficacy findings. The current systematic review provides an updated and focused analysis of the evidence supporting the efficacy of CC. A systematic literature search of MEDLINE, EMBASE, PsycINFO, Cochrane Library, and was conducted, and PRISMA, Cochrane, and GRADE guidelines were followed. Of 2,746 abstracts reviewed, 13 publications, comprising six randomized controlled trials (RCTs) met inclusion criteria. The studies encompassed 6,218 participants across four countries and military, veteran, and civilian health care systems. The primary outcome was suicide mortality; secondary outcomes were suicide attempts and emergency department (ED) presentations/hospitalizations. The DerSimonian–Laird random-effects univariate meta-analysis was used to estimate summary effect sizes and evaluate statistical heterogeneity. Summary risk ratio estimates ranged from 0.57 to 1.29 across outcomes and time points; most estimates indicated a protective effect. For suicide deaths and ED presentations/hospitalization, interval estimates at 1-year postrandomization were consistent with either an increase or a decrease in risk. A protective effect was observed for suicide attempts at 1-year postrandomization. Implications and methodological recommendations for future work in this area reviewed and discussed.

🇨🇦 Argento, E., Strathdee, S., Shoveller, J., Braschel, M., & Shannon, K. (2022). Correlates of suicidality among a community-based cohort of women sex workers: The protective effect of social cohesion. Journal of Interpersonal Violence, 36(19-20), 9709-9724. DOI: 10.1177/0886260519870167
A longitudinal study of women sex workers in Vancouver from 2010-2017. Data were drawn from 867 respondents on questions measuring suicidality, mental health, physical and sexual abuse and other issues.

Abstract – Suicide is a critical public health concern globally. Sex workers experience a disproportionate burden of social and health inequities driven by forms of violence, stigma, and criminalization, yet empirical research on suicidality is limited. This study longitudinally investigated the burden and socio-structural correlates of recent suicidality among women sex workers in Vancouver, Canada. Data (2010-2017) were drawn from a community-based, prospective cohort of cis and trans women sex workers across Metro Vancouver. Women completed biannual interviewer-administered questionnaires, and correlates of suicidality in the last 6 months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Of 867 women at baseline, 48% (n = 413) reported lifetime suicidality, 16% (n = 141) reported suicidality in the last 6 months, and 29% reported suicidality at some point during the study. In multivariable analysis, factors independently associated with suicidality included physical/sexual childhood abuse (adjusted odds ratio [AOR]: 2.99; 95% confidence interval [CI] = [1.75, 5.10]), mental health issues (depression/anxiety/posttraumatic stress disorder; AOR = 2.19; 95% CI = [1.63, 2.95]), intimate partner violence (AOR: 2.11; 95% CI = [1.60, 2.80]), physical/sexual client violence (AOR: 1.82; 95% CI = [1.33, 2.50]), and homelessness (AOR: 1.44; 95% CI = [1.10, 1.89]). Older age (AOR: 0.97; 95% CI = [0.95, 0.99]) and higher social cohesion (AOR: 0.88; 95% CI = [0.78, 0.99]) were significantly associated with reduced odds of suicidality. Findings reveal key socio-structural correlates of suicidality among sex workers including experiences of historical and interpersonal violence, trauma/mental health issues, and homelessness. Strengthening social cohesion may have a protective effect on suicidality. Trauma-informed community-led structural interventions tailored to sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness.

Jones, G.M. & Nock, M.K. (2022). MDMA/ecstasy use and psilocybin use are associated with lowered odds of psychological distress and suicidal thoughts in a sample of US adults. Journal of Psychopharmacology, 36(1), 46-56. DOI: 10.1177/02698811211058923
The associations between the consumption of MDMA/ecstasy, psilocybin, and LSD and suicidal thinking are examined culling data from National Survey on Drug Use and Health (2008-2019) in the United States.

Abstract – Background: Suicide is one of the leading causes of death worldwide and rates within the United States have risen over the past two decades. Hence, there is a critical need for novel tools to treat suicidal ideation and related mental health conditions. 3,4-Methylenedioxymethamphetamine (MDMA)/ecstasy and classic psychedelics may be two such tools. Aims: The aim of this study was to assess non-causal associations between MDMA/ecstasy and classic psychedelic use and psychological distress and suicide risk. Methods: In this study, we examined the aforementioned associations among 484,732 adult participants in the National Survey on Drug Use and Health (2008–2019). Results: Lifetime MDMA/ecstasy use was associated with reduced odds of past year suicidal thinking (10% reduced odds; odds ratio (OR) = 0.90; 95% confidence interval, CI = (0.84–0.97); p < 0.01) and past year suicidal planning (OR = 0.88; 95% CI = (0.78–0.99); p < 0.05). Furthermore, lifetime psilocybin use was associated with reduced odds of past month psychological distress (OR = 0.78; 95% CI = (0.73–0.84); p < 0.001) and past year suicidal thinking (OR = 0.90; 95% CI = (0.83–0.96); p < 0.01). Finally, lysergic acid diethylamide (LSD) was associated with increased odds of past year suicidal thinking (OR = 1.07; 95% CI = (1.00–1.15); p < 0.05). Conclusion: MDMA/ecstasy and psilocybin use are associated with reduced odds of suicidal thinking and related outcomes—though experimental studies are needed to determine whether these associations are causal. These findings call for more research into the efficacy of MDMA/ecstasy and classic psychedelics for treating psychological distress and suicidal thoughts and behaviors, and for updated drug legislation that allows for further investigation into these substances.

Whisenhunt, J., Biber, D., & Heidorn, B. (2022). On the front line: The role of physical educators in preventing student suicide. Journal of Physical Education, Recreation & Dance, 93(3), 25-31. DOI: 10.1080/07303084.2021.2022039
A paper recognizing physical education teachers hold a key and strategic position within a school community and should be equipped with suicide prevention knowledge and skills.

Abstract – This article provides general information and guidance for physical educators, specifically related to their role in suicide prevention. It is the duty of school personnel to recognize the vital role they have in helping to prevent suicide, to promote healthy behaviors and positive relationships, and to appropriately talk about suicide and suicide attempts. Physical educators, therefore, should have knowledge of the risk factors, understand the underlying concepts of suicidal behaviors, be aware of their responsibility to help educate others, and provide meaningful teacher- and student-based modeling and mentoring opportunities in physical education programs.

Duval, B., Guziewicz, P., McCauley, J., Berkowitz, L., & Peterson, E. (2022). The first 72 hours: Suicide loss survivor experiences with early responders. Death Studies. DOI: 10.1080/07481187.2022.2063455
A study of the interactions between loss survivors and first responders in the first 72 hours after a suicide.

Abstract – Exposure to a suicide carries risks for loss survivors including significant and long-standing emotional distress. Early responders play a critical role in shaping survivors’ experience and trajectory for seeking support services. Yet, few prior studies explore the nuances of early responders’ interactions with loss survivors. The current study explored suicide-bereaved adults’ experiences with early responders in the first 72 h after their loss through four group interviews. Participants (N = 15) indicated that interactions with early responders were positive overall. Yet, the lack of resources and referrals provided, and perceived stigmatization of suicide may contribute to survivors’ delay in obtaining support services.

Marchi, M., Artoni, C., Longo, F., Magarini, F., Aprile, G., Reggianini, C., Florio, D., De Fazio, G., Galeazzi, G., & Ferrari, S. (2022). The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort  of migrant detainees: An observational,  prospective study. International Journal of Social Psychiatry, 68(3), 514-524. DOI: 10.1177/0020764020979007
A cohort study was conducted on migrant detainees in an Italian jail between February 2017 and September 2019. The aim was to measure the impact of trauma on suicidal and self-harming behaviours on this population.

Abstract – Background: According to the WHO, detainees attempt suicide ten times more than the general population. Aims: To investigate the impact of migration trauma on Suicidal and Self-Harm Behaviours (SSHB) of migrants in jail and to explore how substance use and other psychiatric features affect this relationship. Methods: Prospective cohort study, conducted at the ‘Sant’Anna’ jail in Modena (Italy) between February 2017 and September 2019. Socio-demographic, psychiatric features and records of previous SSHB were collected. Experience of migration-related trauma was assessed with the LiMEs (List of Migration Experiences) checklist. Participants were followed-up for the occurrence of further SSHB. Survival analysis was performed and Cox’s Hazard Ratios (HR) were used as a measure of association of comparisons. Results: Amongst the 112 subjects (96% male, median age 33), the prevalence of any mental disorder was 26% and of substance abuse 59%. History of SSHB was present in 36% of the sample. Median follow-up time was 80 days. During follow-up, 11 events were observed (of which three were suicide attempts). Cumulative survival probability was 85%. Having experienced trauma related to war and violence was significantly associated with SSHB, HR: 7.05. No SSHB were recorded amongst subjects without substance abuse. Conclusions: Migrants in custody who experienced trauma in the post-migration period, attempt SSHB seven times more frequently than those without traumas at any time. War trauma and post-migration trauma due to exposure to violence seem to be more strongly associated with SSHB, also controlling for psychiatric diagnosis, ongoing psychopharmacological therapy and substance abuse. Further research and possible intervention programs should focus on addressing post-migration living-difficulties.

Ranning, A., Madsen, T., Hawton, K., Nordentoft, M., & Erlangsen, A. (2022). Transgenerational concordance in parent-to-child transmission of suicidal behaviour: A retrospective, nationwide, register-based cohort study of 4419642 individuals in Denmark. Lancet Psychiatry, 9(5), 363-374. DOI: 10.1016/S2215-0366(22)00042-6
A retrospective Danish study of data national register data examining whether there is an association between suicidal behaviour in parents and the presence of suicidal behaviour in their children.

Abstract – Background: Suicidal behaviour runs in families, but the nature of transgenerational concordance needs elucidation. The aim of this study was to examine parent-to-child transmission by investigating whether presence and nature of parental suicidal behaviour was associated with suicidal behaviour in children. Methods: We did a retrospective, nationwide, register-based cohort study in Demark using register data. We included all individuals born after 1953 who were 10 years or older and who were recorded as living in Denmark at some point between Jan 1, 1980, and Dec 31, 2016. Adults listed as living with their child at first registration in the Civil Registration System were considered as parents; later records of different legal parents allowed identification of potential step-parents. Self-reported ethnicity data were not available. Exposure to parental suicide attempt and suicide was identified using information from hospital contacts and causes of death from national registers. The examined outcomes were suicide attempt and death by suicide. We calculated incidence rate ratios (IRRs) and cumulative hazards for children’s suicide attempt and suicide, taking into account type of parental suicidal behaviour, child’s age of exposure, and sex. Findings: In total, 4 419 642 individuals aged 10–63 years were observed during 1980–2016. Of these individuals, 150 222 (3·4%) were exposed to one or more parents with a suicide attempt, 31 564 (0·7%) to at least one parent who died by suicide, and 12 834 (0·3%) to both events. Individuals exposed to parental suicide attempt had higher rates of suicide attempt (IRR 2·72 [95% CI 2·33–3·17]) than individuals exposed to parental suicide (1·77 [1·50–2·09]) when compared with unexposed individuals. Higher rates of suicide were found for individuals exposed to parental suicide (IRR 3·18 [95% CI 2·84–3·58]) than for those exposed to parental suicide attempt (2·37 [2·19–2·57]). The cumulative hazard of suicide attempt was 0·07 for individuals exposed to parental suicide attempt, and the cumulative hazard of suicide was 0·009 for individuals exposed to parental suicide. Individuals exposed to parental suicide had higher odds of violent suicidal methods than those exposed to suicide attempt alone (odds ratio 2·0 [95% CI 1·7–2·3]). Interpretation: A concordant pattern of higher rates of the same type of suicidal behaviour as the one of the parents was observed, including type of suicide method. Preventive, family-oriented interventions are warranted to mitigate familial transmission of risk, as are clinical considerations of familial exposure in risk assessment of patients.

Hennefield, L., Hao, J., Joiner, T., Whalen, D., Giorio, C., & Luby, J. (2022). Young children with suicidal thoughts and behaviors more likely to resolve conflicts with violence, homicide, or suicide: A study of internal working models using narratives. Journal of Psychopathology and Clinical Science,131(1), 26–33. DOI: 10.1037/abn0000723
This study looked at the suicidal ideation of young children, between the ages of 3 and 6, and their understanding and perception of violence, death, and suicide.

Abstract – There is mounting evidence that young children who express suicidal ideation (SI) have a different conceptualization of death than their peers. This study characterizes 3- to 6-year-olds’ depictions of violence, death, and suicidal themes in a story completion task as a function of their history of SI. Participants were 228 children with depression (3.0–6.9 years) who completed a comprehensive psychiatric assessment and four story stem narratives. For each narrative, an interviewer began a story with a conflict that the child was encouraged to resolve. Children’s resolutions were coded for standard themes and negative atypical themes including violence and homicide, accidental harm or death, and suicidal ideation/acts. Themes were examined as a function of children’s SI status: active-SI (n = 25), passive-SI (n = 28), or no history of SI (n = 175). Across the narratives, 89 children described at least one negative atypical theme: violence or homicide (n = 78), accidental harm or death (n = 22), and suicide (n = 13). The responses of children with active-SI included significantly more violence or homicide than children without SI. Moreover, current active-SI predicted suicidal themes. There were no group differences in accidental harm or death, nor in common aggressive or punitive acts (e.g., hitting, yelling, spanking), indicating specificity between active-SI and more intense violence and death-related themes. In sum, young children with active SI are more likely than their depressed peers without SI to incorporate violence, homicide, and suicide into their narratives around conflict resolution. These themes appear more salient to depressed children with SI and pervasive in their thoughts and problem-solving strategies.

Westcott, J., Fullen, M., Tomlin, C., Eikenberg, K., Delaughter, P., Mize, M., & Shannonhouse, L. (2022). “Listen closer”: Home delivered meal volunteers’ understanding of their role in suicide intervention. Ageing & Society. DOI: DOI : 10.1017/S0144686X22000368
This is a study of 20 Home Delivered Meals volunteers (natural helpers) who received ASIST training and its effect on engaging with older adults and their mental health concerns.

Abstract – Suicide in later life is a pressing public health concern, which has likely been exacerbated by the COVID-19 pandemic. Many older adults who need mental health treatment do not have access to necessary services and training for mental health providers to support older adults experiencing suicidality is limited. One solution is developing interventions based in a public health approach to suicide prevention, whereby natural helpers who provide community services are mobilised to respond to older persons-at-risk. Home-delivered meal (HDM) services, for example, are one effective means to reach older adults who are isolated due to being homebound and may be instrumental in preventing suicide. This study examined the experiences of 20 HDM volunteers who received Applied Suicide Intervention Skills Training (ASIST), an evidence-based suicide intervention programme. Phenomenological analysis yielded findings centred on three areas demonstrating the impact of the ASIST training on HDM volunteers: putting asist skills into practice; response to ASIST skills; and role transformation. Implications for integrating suicide prevention efforts with HDM services and directions for future research are discussed.

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