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

🇨🇦 Tsai, M., et al. (2020, September 8). Examining the Three-Step Theory (3ST) of suicide in a prospective study of adult psychiatric inpatients. Behavior Therapy.
The Three Step Theory (3ST) of suicide, an “ideation to action” theory of suicide, is applied to adult psychiatric patients in British Columbia.

Abstract – This study examined the validity and predictive utility of Three-Step Theory (3ST) of Suicide in psychiatric patients. Participants were 190 consecutively admitted adult psychiatric inpatients (53% female; 60% Caucasian; ages 18–73) assessed at three time-points: baseline, 4 weeks later (n = 112), and 3 months post-discharge (n = 102). Results were broadly supportive of the 3ST. First, at baseline, an interactive model of pain and hopelessness accounted for substantial variability in suicidal desire, even when controlling for depression and lifetime ideation. This result replicated in different genders and age ranges (i.e., 18–32 and 33–73). Further, pain and hopelessness were robust predictors of suicidal desire weeks and months into the future. Second, among those with pain and hopelessness, lower connectedness, as well as the extent to which pain exceeds connectedness, were robust predictors of higher suicidal desire. Lastly, a baseline measure of practical capability for suicide predicted suicide attempts both retrospectively and prospectively, even when controlling for lifetime ideation; however, dispositional and acquired contributors to capability were less predictive. Results support the validity and predictive utility of the 3ST, and suggest that the theory may have utility for guiding risk assessment and intervention.

Licence, L., et al. (2020). Prevalence and risk-markers of self-harm in autistic children and adults. Journal of Autism and Developmental Disorders.
Autistic children who lack intellectual disability are not well researched in the literature. This study looks at the prevalence of self-harming among them.

Abstract – Self-harm is purportedly common in autistic individuals, but under-researched, particularly in younger samples and those without intellectual disability. This study aimed to describe prevalence, profile and correlates of self-harm in autistic individuals without impairments in adaptive functioning. Parents of autistic participants (n = 83) completed questionnaires regarding the presence/topography of self-harm, demographic characteristics, autism severity, age of diagnosis, affect, activity levels and repetitive behaviour. 24.10% of participants engaged in self-harm. Self‐harm was associated with significantly higher levels of impulsivity, over-activity, negative affect, compulsive behaviour and insistence on sameness. Low mood and overactivity/impulsivity predicted the presence of self-harm, with the model correctly classifying 82.9% of cases. Findings highlight a role for impaired behavioural inhibition and low mood in the aetiological mechanisms underpinning self-harm in autism.

Edwards, D. & Wilkerson, N. (2020). Emotional exhaustion and its relationship with suicide risk in emergency responders. Psychiatry Research, 293, 113379.
The concept of burnout and one of its outcomes, emotional exhaustion, and its relationship with suicide risk is examined among emergency responders.  

Abstract – The purpose of the current study was to evaluate the relationship between emotional exhaustion and suicide risk in emergency responders. Participants included 643 actively employed emergency responders who responded to an online research based survey. Participants were administered the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981) and the Suicide Behaviors Questionnaire (SBQ-R; Osman, Bagge, Gutierrez, Konick, Kooper, & Barrios, 2001). Using a categorical measure of emotional exhaustion, responders reported a statistically significant increased suicide risk [F(2, 640) = 45.01, p < .001] between levels of emotional exhaustion. Post hoc analysis confirmed significant differences between each level of emotional exhaustion with a significant increase of risk at each category (Low [M = 4.60, SD= 2.38], Moderate [M = 5.56, SD= 2.50], High [M = 6.95, SD= 3.26]). Emergency responders with high levels of emotional exhaustion had an average suicide risk score approaching the significant risk cut-off of 7.

Gratch, I., et al. (2020). Detecting suicidal thoughts: The power of ecological momentary assessment. Depression & Anxiety, 1-9.
Researchers compare suicidal ideation information gleaned from mobile Ecological Momentary Assessment (EMA) via smartphone technology versus traditional clinical retrospective reports on suicidal ideation.

Abstract – Background: Researchers and clinicians have typically relied on retrospective reports to monitor suicidal thoughts and behaviors. Smartphone technology has made real‐time monitoring of suicidal thoughts possible via mobile ecological momentary assessment (EMA). However, little is known about how information gleaned from EMA compares with that obtained by retrospective reports. The authors sought to compare suicidal ideation (SI) assessed over 1 week using EMA with a retrospective gold‐standard interviewer‐administered measure covering the same period. Methods: Fifty‐one adults with major depressive disorder completed 1 week of EMA (6×/day) assessing SI. Following completion of EMA, participants completed an interviewer‐administered Scale for Suicide Ideation (SSI) retrospectively assessing the same week. Results: SI severity assessed through EMA was positively correlated with scores on the retrospective SSI. However, 58% of participants reporting ideation with EMA denied any past‐week ideation on the SSI. Participants who endorsed SI during EMA but not on the SSI were no less likely to have a history of suicidal behavior than those who reported SI in both formats. Conclusion: EMA captures instances of suicidal thinking that go undetected through retrospective report and thereby may help us to identify an at‐risk subgroup otherwise missed.

🇨🇦 Antebi, L., et al. (2020). Assessing adherence to responsible reporting of suicide guidelines in the Canadian news media: A 1-year examination of day-to-day suicide coverage. Canadian Journal of Psychiatry, 65(9), 621-629. DOI: 10.1177/0706743720936462
A study of Canadian mainstream media suicide reportage from April 2019 to March 2020. The primary focus was on adherence to responsible media reporting of suicide guidelines.

Abstract – Objective: This study aims to examine routine day-to-day suicide reporting in the Canadian media, giving a descriptive overview of the tone and content of news articles. The primary objective is to assess adherence to responsible reporting of suicide recommendations in news articles about suicide. A secondary objective is to categorize these articles according to their focus. A tertiary objective is to compare guideline adherence across the different categories of articles. Methods: We collected news articles containing the keyword “suicide” from 47 Canadian news sources between April 1, 2019, and March 31, 2020. Articles were read and coded for their adherence to responsible reporting of suicide recommendations. Articles were also allotted into categories according to their focus and primary suicide discussed. Frequency counts and percentages of adherence were calculated for all key variables-both overall and by category of article. Chi-square tests were also conducted to assess for variations in adherence by category of article. Results: The procedures resulted in 1,330 coded articles. On the one hand, there was high overall adherence to several recommendations. For example, over 80% of articles did not give a monocausal explanation, glamourize the death, appear on the front page, include sensational language, or use discouraged words. On the other hand, there was low adherence to other recommendations, especially those related to putatively protective content. For example, less than 25% included help-seeking information, quoted an expert, or included educational content. Cross-category analysis indicated that articles about events/policies/research and Indigenous people had the highest proportions of adherence, while articles about murder-suicide and high-profile suicides had the lowest adherence. Conclusions: While a substantial proportion of articles generally adhere to suicide reporting recommendations, several guidelines are frequently underapplied, especially those concerning putatively helpful content. This indicates room for improvement in the responsible reporting of suicide.

🇨🇦 Fuller-Thomson, E., et al. (2020). Factors associated with recovery in Aboriginal people in Canada who had previously been suicidal. Archives of Suicide Research, 24(2), 186-203. DOI: 10.1080/13811118.2019.1612801
An analysis of Indigenous people living off-reserve and their experiences with recovery from suicidal ideation. Date were culled from the 2012 Aboriginal Peoples Survey, a Canadian national sample of Indigenous people living off-reserve.

Abstract – To explore factors associated with recovery from suicidal ideation among Aboriginal peoples living off reserve in Canada. Recovery is defined as being free of serious suicidal thoughts for the past year. Data for this study came from the 2012 Aboriginal Peoples Survey, a nationally representative sample of Aboriginal peoples in Canada who are living off-reserve. The sample consisted of those who had seriously considered suicide at some point in their life (n = 2,680). Those who had been suicidal in the past year were compared to those who were no longer suicidal using Pearson chi-square and logistic regression analyses. Several factors were associated with recovery among Aboriginal peoples living off-reserve in Canada who had previously been suicidal. Recovery was higher among women, individuals who were older, and those who were food secure, spoke an Aboriginal language, had a high school degree, had a confidant, and had no previous diagnosis of mood disorders or learning disability. Several sociodemographic factors appear to influence recovery from suicidality among Aboriginal peoples. Intervention approaches to promote recovery from suicidal ideation would benefit from targeted outreach, a strength-based, culturally-specific approach using traditional practices, and encouraging involvement of various community members to foster resilience and formation of relationships.

Riedinger, M. & de Winter, R. (2020). Evidence for underregistration of suicide. Case Reports in Psychiatry.
Under-reporting of suicide is a recognized phenomenon world-wide. This article presents two case studies from the Netherlands that illustrate its prevalence.

Abstract – In this case report, we will present two cases in which the Dutch municipal coroner registered a natural death, but treating psychiatrists doubted the validity of this decision on the grounds of clinical data and investigation. For both cases, we present evidence that deaths likely resulted from suicide, raising serious doubts about the accuracy of the registered cause of death. According to the WHO bulletin on suicide prevention, the national registration of suicide is unsatisfactory in many countries. The Netherlands is listed by the WHO as having one of the most accurate registration procedures. Nevertheless, there are indications that national registration, even in the Dutch system, is not infallible. In this case report, we present several ways in which the registration process is liable to error and evidence for under registration of suicide rates.

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