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

Abbott-Smith, S. et al. (2023). Suicide prevention: What does the evidence show for the effectiveness of safety planning for children and young people? A systematic scoping review. Journal of Psychiatric and Mental Health Nursing.

The efficacy of the safety planning intervention (SPI) for adults is well established. This is a review of 15 studies examining its efficacy among children and young people.

Abstract – Introduction: Suicide is a leading cause of death for children and young people and its prevention is a global priority. Many Mental Health Services employ safety planning as a brief intervention. There is some evidence of safety planning effectiveness for adults, but little is known about its effectiveness with young people. Aim: To synthesize research reporting safety planning effectiveness for children/young people with suicidal ideation and identify good practice recommendations. Inclusion criteria: The review relates to safety planning around suicide prevention for children/young people aged less than 18 years, even if it was within a wider intervention. The review was inclusive of all clinical areas (including mental health, primary care, etc.), any geographical location or social economic status and inclusivity around the method of delivery. Methods: A systematic scoping review of literature reporting effectiveness data for the use of safety planning with children/young people with suicidal ideation. The systematic scoping review protocol (pre-registered with Open Science Framework) followed Joanna Briggs Institute conduct guidance and PRISMA-ScR checklist. Data analysis and presentation: Fifteen studies were reported during 2008–2021. Overall, there is promising, but limited, evidence of effectiveness for safety planning for children/young people but with complete evidence gaps for some demographic sub-groups. Evidence determined that healthcare professionals should deliver a safety planning intervention that is completed collaboratively, developmentally appropriate, and recognizes parental/carer involvement. Discussion and implications for practice: Further research is needed but current evidence suggests safety planning should be a routine part of care packages for children/young people with suicidal ideation proportionate to their needs. Developing/implementing these plans needs bespoke health professional training and additional support and resources for parents/carers should be developed.

Balt, E. (2023). Social media use of adolescents who died by suicide: Lessons from a psychological autopsy study. Child and Adolescent Psychiatry Mental Health.   

Psychological autopsies were conducted on 35 adolescents who died by suicide in the Netherlands. Researchers were looking for associations of their social media habits and subsequent suicides. 

Abstract –Background: while there are many benefits for young people to use social media, adverse effects such as cyberbullying, online challenges, social comparison and imitation may provoke and aggravate suicidal thoughts and behaviors. The influence of social media on mental health and suicidal thoughts and behaviours has been amply studied, but there is little empirical evidence for its potential role in adolescent suicides. The current study aimed to inform digital suicide prevention strategies by examining the meaning of social media in the lives of young suicide victims and elucidating the harmful and supportive effects of social media use on their wellbeing and distress. Methods: data were analyzed from a psychological autopsy study of 35 adolescents who died by suicide in the Netherlands (43% of all adolescents who died by suicide in that year). These were 18 girls and 17 boys. All were under the age of twenty years, with an average of seventeen years. Interpretative Phenomenological Analysis was performed of 55 semi structured interviews with peers and parents of the decedents. Results: young people benefitted from peer support and recovery stories. However, various themes were discussed relating to the harmful effects of social media, including dependency, triggers and imitation, challenges, cybervictimization and psychological entrapment. The themes of dependency and triggers and imitation were more salient in young females. A group of girls cultivated an online identity around their suicidal thoughts and behaviours. Next-of-kin, particularly parents, faced various challenges to talk to the adolescents about social media use, including technological illiteracy, online anonymity, and the youths’ closedness. Conclusions: based on the findings, we recommend education to stimulate the digital literacy of parents, health workers and educators, supporting conscientious social media use in young people, and extending the prevention of cyberbullying. We encourage future research to examine how virtual social networks may sustain suicidal thoughts and behaviour, and to further investigate the effectiveness of digital interventions, like moderated peer support and the use of positive role models. 

de la Torre-Luque, A. et al. (2023). Risk of suicide attempt after an index attempt: A systematic review and meta-analysis. General Hospital Psychiatry.  

This is a systematic review of 110 studies measuring the risk of repeat suicide attempts after an initial attempt.  

Abstract – Objectives: To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. Methods: This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. Results: A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. Conclusion: One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives. 

DuBois, D. et al. (2023). A scoping review of military and Veteran families within international suicidality and suicide prevention research. Preventative Medicine Reports.  

This is a review of research concerning suicide and suicide prevention among military and Veteran families. 51 studies were included. Most of the studies focused on suicide, as opposed to suicide prevention. 

Abstract – The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted, and 4,835 studies were screened. All included studies underwent quality assessment. Bibliographic, participant, methodological, and family-relevant data was extracted and descriptively analyzed into Factors, Actors, and Impacts. In total, 51 studies (2007 – 2021) were included. Most studies focused on suicidality rather than suicide prevention. Factor studies described family constructs as a suicidality risk or protective factor for military personnel or Veterans. Actor studies described families’ roles or responsibilities to act in relation to the suicidality of military personnel or Veterans. Impacts studies described the impacts of suicidality on military and Veteran family members. The search was limited to English language studies. There were few studies on suicide prevention interventions for or including military and Veteran family members. Family was typically considered peripheral to the military personnel or Veteran experiencing suicidality. However, there was also emerging evidence of suicidality and its consequences in military-connected family members.  

🇨🇦 Jarvis, G.E. & Kirmayer, L.J. (2023). Global migration: Moral, political and mental health challenges. Transcultural Psychiatry. 60(1), 5–12.  

The editors (Jarvis and Kirmayer) of McGill’s Transcultural Psychiatry describe the current issue, which is devoted to the theme of global migration and mental health. A couple of the articles included within the issue are: “Help-seeking strategies and treatment experiences among individuals with Bipolar Spectrum Disorder in Iran: A qualitative study” and “The association of mindfulness and depression stigma among African American women participants in a mindfulness-based intervention: A pilot study”, among others. 

Abstract – Global migration is expected to continue to increase as climate change, conflict and economic disparities continue to challenge peoples’ lives. The political response to migration is a social determinant of mental health. Despite the potential benefits of migration, many migrants and refugees face significant challenges after they resettle. The papers collected in this thematic issue of Transcultural Psychiatry explore the experience of migration and highlight some of the challenges that governments and healthcare services need to address to facilitate the social integration and mental health of migrants. Clinicians need training and resources to work effectively with migrants, focusing on their resilience and on long-term adaptive processes. Efforts to counter the systemic discrimination and structural violence that migrants often face need to be broad-based, unified, and persistent to make meaningful change. When migrants are free to realize their talents and aspirations, they can help build local communities and societies that value diversity. 

🇨🇦 Khan, A. & Ungar, M. (2023). Resilience to self-harm: A scoping review of protective factors that aid in recovery among marginalized young people. Crisis. 44(1), 61–69.  

Most studies of self-harm and resiliency have been conducted in Western countries with little focus on marginalized youth. This review looks at research on resiliency among youth who engage in self-harm living in low and middle-income countries (LMICs). 

Abstract – Background: Although a wide range of studies discuss prevalence and risk factors associated with self-harm, protective factors that are equally important are rarely explored. Moreover, much of our understanding of young individuals who engage in self-harm come from studies conducted in Western countries with very little emphasis on marginalized groups. Aim: This scoping review identifies research on resilience among marginalized youth and youth living in low- and middle-income countries (LMICs) who show evidence of self-harm. Method: A scoping review following Arksey and O’Malley’s (2005) framework was conducted. This effort included drawing upon peer-reviewed research published between January 2000 and September 2020 to identify protective factors and coping strategies that are employed by individuals 10–29 years old with self-harming tendencies. Results: A total of 15 original papers met the inclusion criteria. The majority of the LMIC publications were from China. Social support, positive youth development, and religiosity were the most frequently reported protective factors. Conclusion: Despite widespread concern about self-harm, there are few peer-reviewed articles that look at resilience or recovery among youth in LMICs and among marginalized young people. In addition to various internal and external protective factors, this scoping review identifies gaps in our understanding of resilience to self-harm among youth belonging to these groups. 

Kleiman, E. et al. (2023). The use of advanced technology and statistical methods to predict and prevent suicide. Nature Reviews Psychology. 

The authors examine the efficacy of suicide risk assessment and whether advances in technology will enhance future assessment endeavours. 

Abstract – In the past decade, two themes have emerged across suicide research. First, according to meta-analyses, the ability to predict and prevent suicidal thoughts and behaviours is weaker than would be expected for the size of the field. Second, review and commentary papers propose that technological and statistical methods (such as smartphones, wearables, digital phenotyping and machine learning) might become solutions to this problem. In this Review, we aim to strike a balance between the pessimistic picture presented by these meta-analyses and the optimistic picture presented by review and commentary papers about the promise of advanced technological and statistical methods to improve the ability to understand, predict and prevent suicide. We divide our discussion into two broad categories. First, we discuss the research aimed at assessment, with the goal of better understanding or more accurately predicting suicidal thoughts and behaviours. Second, we discuss the literature that focuses on prevention of suicidal thoughts and behaviours. Ecological momentary assessment, wearables and other technological and statistical advances hold great promise for predicting and preventing suicide, but there is much yet to do.  

🇨🇦 Mishara, B.L. et al. (2023). Systematic review of research and interventions with frequent callers to suicide prevention helplines and crisis centers. Crisis. (2023). 44(2), 154–167.  

27 studies examining frequent callers to suicide prevention helplines were analyzed to craft recommendations for helpline responses.  

Abstract – Background: Helplines worldwide have frequent callers who may occupy a large proportion of call volume. Therapeutic gain from frequent calling has been questioned. We conducted this review to identify the characteristics of frequent callers and to compile recommendations about how best to help them. Method: Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards, we searched for all empirical research in English and French from inception to May, 2020 in PubMed, PsycInfo, and the CRISE library. Results: We identified 738 manuscripts and retained 27 for analyses. Nine provided no definition of frequent callers; nine mixed frequent callers with repeat callers (>1 calls); nine concerned frequent callers (≥8 calls/month). The limited data suggest frequent callers are similar to other callers and often experience mental health problems, loneliness, and suicide risk. From recommendations in all 27 studies, we identified 10 suggestions to better manage and help frequent callers that merit validation. Limitations: The small number of empirical investigations and the diversity of their goals and methodologies limit generalizations. Although recommendations for helping callers may have face validity, empirical data on their effectiveness are scarce. Conclusion: Rather than focusing on reducing call frequency, we should empirically evaluate the benefits of interventions for frequent callers with different calling patterns, characteristics, and reasons for calling. 

🇨🇦 Nisbet, J. et al. (2023). Suicidal ideation, planning and attempts among new Royal Canadian Mounted Police cadets. The Canadian Journal of Psychiatry.  

This is a study measuring suicidal behaviours among RCMP cadets within one month of beginning the RCMP Cadet Training Program (CTP). 

Abstract – Background: Royal Canadian Mounted Police (RCMP) report diverse occupational stressors and repeated exposures to potentially psychologically traumatic events, which may increase the odds of screening positive for a mental disorder, and increase the risk of death by suicide. The current study was designed to provide prevalence information regarding suicidal behaviours (i.e., ideation, planning, attempts) and assess for sociodemographic differences among cadets at the start of the RCMP Cadet Training Program (CTP). Method: Cadets (n = 736, 74.0% male) were administered the structured Mini International Neuropsychiatric Interview by a mental health clinician or a supervised clinical psychologist trainee. The interview includes an assessment of past month suicidal ideation, planning, attempts and lifetime suicide attempts. Results: Within 1 month of starting the CTP, a small percentage of cadets reported past month suicidal ideation (1.6%) and no cadets reported any suicidal planning (0%) or attempts (0%). Lifetime suicide attempts were reported by (1.5%) of cadets. Conclusions: The current results provide the first information describing the prevalence of suicidal ideation, planning, and attempts among RCMP cadets starting the CTP. The estimates of suicidal behaviours appear lower than the general population and lower than reports from serving RCMP. Higher prevalence estimates of suicidal behaviours reported by serving RCMP. 

O’Connell, S. et al. (2023). “That feeling of solidarity and not being alone is incredibly, incredibly healing”: A quality study of participating in suicide bereavement support groups. Death Studies. 

Abstract In this qualitative study, 12 participants in suicide bereavement support groups were interviewed and shared their impressions of participation in these groups. 

Abstract – Suicide can have a significant impact on the bereaved. Peer support groups for suicide bereavement have been shown to enhance the wellbeing of those attending. However, research is lacking on the mechanisms that underlie these benefits. Semi-structured interviews were conducted with 12 adults attending peer-facilitated support groups in Ireland and thematic analysis was used. The findings highlighted the enduring emotional impact including guilt and questioning, loss of identity, as well as wider impacts. Mechanisms of the groups included the opportunity to share experiences and feel validated, connection and belongingness and collective processing of grief. Groups were found to have a unique role alongside other informal and formal supports. This study highlights the important role of peer support groups in lessening this burden and adds to the literature through identifying potential mechanisms by which peer support groups contribute to improved wellbeing for the suicide-bereaved and practical steps to facilitate these mechanisms. 

Pirkis, J. et al. (2023). A public health, whole-of-government approach to national suicide prevention strategies. Crisis, 44(2), 85-92. 

In this editorial, the authors recommend increasing focus on social determinants of health (SDOH) in association with suicide and self-harm when drafting national suicide prevention strategies. 

Abstract – Many countries have national suicide prevention strategies, all of which aim to reduce suicide and many of which also address self-harm more generally (World Health Organization, 2018). In this editorial, we argue that national strategies could be strengthened through an increased focus on the social determinants associated with suicide and self-harm. We present a public health model that articulates how these social determinants might operate and how they might interact with individual-level risk factors. We then describe how these social determinants might be addressed by a whole-of-government approach involving cross-sectoral action and genuine social participation and empowerment of people with lived experience of suicide and self-harm. 

🇨🇦 Rauch, K. et al. (2023). Suicidality in rural communities: A scoping review of research in Canada. Canadian Journal of Community Mental Health. 42(1).  

A scoping review of 39 studies looking at suicide and suicidal behaviours in rural and remote Canadian communities. Most of the studies consisted of quantitative research and were published between 2009 and 2020. 

Abstract – A scoping review of research about suicidality in rural and remote Canadian communities, published between 2009 and July 2020 was conducted by searching Embase, Medline, CINAHL, PsychInfo, SocIndex, Geobase, and PsycArticles databases. Included articles were reviewed and charted using data extraction. Thirty-nine Canadian, non-Indigenous articles met inclusion. Most publications were based on quantitative research (23). Apart from one intervention study, articles were prevention focused, with suicidality risk and protective factors noted to be of particular interests. The most frequently referenced suicidality risk factor was rural residence. It is anticipated that results of this review will inform future research, particularly the need to include qualitative and mixed methodologies, protocol, and evaluations of interventions as well as postvention research, with further consideration of different Canadian settings and populations. 

🇨🇦 Saunders, N. et al. (2023). Suicide and self-harm among immigrant youth to Ontario, Canada from Muslim majority countries: A population-based study. The Canadian Journal of Psychiatry.  

This is a study of suicide and self-harming behaviours among youth from Muslim majority countries who immigrated to Canada from 2003-2017. 

Abstract – Objective: To examine the association between Muslim religious affiliation and suicide and self-harm presentations among first- and second-generation immigrant youth. Methods: We performed a population-based cohort study involving individuals aged 12 to 24 years, living in Ontario, who immigrated to Canada between 1 January 2003 and 31 May 2017 (first generation) and those born to immigrant mothers (second generation). Health administrative and demographic data were used to analyze suicide and self-harm presentations. Sex-stratified logistic regression models generated odds ratios (OR) for suicide and negative binomial regression models generated rate ratios (aRR) for self-harm presentations, adjusting for refugee status and time since migration. Results: Of 1,070,248 immigrant youth (50.1% female), there were 129,919 (23.8%) females and 129,446 (24.2%) males from Muslim-majority countries. Males from Muslim-majority countries had lower suicide rates (3.8/100,000 person years [PY]) compared to males from Muslim-minority countries (5.9/100,000 PY) (OR: 0.62, 95% CI, 0.42-0.92). Rates of suicide between female Muslim-majority and Muslim-minority groups were not different (Muslim-majority 1.8/100,000 PY; Muslim-minority 2.2/100,000 PY) (OR: 0.82, 95% CI, 0.46-1.47). Males from Muslim-majority countries had lower rates of self-harm presentations than males from Muslim-minority (<10%) countries (Muslim majority: 12.2/10,000 PY, Muslim-minority: 14.1/10,000 PY) (aRR: 0.82, 95% CI, 0.75, 0.90). Among female immigrants, rates of self-harm presentations were not different among Muslim-majority (30.1/10,000 PY) compared to Muslim-minority (<10%) (32.9/10,000 PY) (aRR: 0.93, 95% CI, 0.87-1.00) countries. For females, older age at immigration conferred a lower risk of self-harm presentations. Conclusion: Being a male from a Muslim-majority country may confer protection from suicide and self-harm presentations but the same was not observed for females. Approaches to understanding the observed sex-based differences are warranted. 

Vanderburg, J.L. et al. (2023). Caregiver experiences of adolescent school reentry after adolescent hospitalization due to suicidal thoughts and behaviors: Recommendations to improve reentry practices. Journal of School Health. 93(3), 206-218. 

There are several studies examining adolescent return to school after hospitalization due to suicidal behaviours. However, there is a lack of evidence looking at the experiences and thoughts of caregivers about school re-entry for those in their care. This study offers recommendations to improve re-entry practices from their perspective. 

Abstract – Background: Suicide rates among adolescents increased over the past few decades. Following psychiatric hospitalization, many adolescents return to school, a context that can influence recovery. Families can play an integral role in supporting adolescents through the hospitalization and school reentry process; however, little research has focused on family experiences during adolescent school reentry. Grounded in ecological systems theory, the aim of the present study was to explore the experiences of caregivers whose children were hospitalized for suicidal thoughts and behaviors (STBs) and provide recommendations for the school reentry process. Methods: In-depth interviews were conducted with caregivers (n = 19) whose adolescents returned to school following hospitalization for suicide-related crises. Researchers analyzed the transcribed interviews using applied thematic analysis. Results: Themes emerged regarding academic difficulties during hospitalization; breakdowns in communication between schools, families, and hospitals; logistical challenges during the school reentry planning process; and challenges navigating peer relationships and academics following school reentry. Implications and Conclusions: Few reentry recommendations account for the specific challenges faced by families. Recommendations informed by caregiver experiences are needed to ensure that families can effectively support the recoveries of their children. This study presents caregiver-informed recommendations to facilitate an improved reentry process for caregivers and adolescents. 

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