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

🇨🇦 Langmann, C. (2021). Suicide, firearms, and legislation: A review of the Canadian evidence. Preventive Medicine. 152 (Pt. 1), 106471. DOI:10.1016/j.ypmed.2021.106471
Canada legislated firearm controls in 1977, 1991, and 1995. This is a review of 13 studies examining the effects of this firearm regulation legislation on suicide.

Abstract – Suicide accounts for approximately 4000 deaths a year in Canada, of which about 16% of those are suicide using a firearm. Canada has undertaken legislative efforts to regulate and control firearms, Bill C-51 in 1977 and Bills C-17 and C-68 in 1991 and 1995. Regulatory approaches that decrease the availability of firearms are hypothesized to reduce suicide by firearm however the substitution effect suggests it is possible that people may substitute other methods of suicide in place. Canadian studies on associations between legislation, regulation, and suicide rates have been published over the last three decades, and a search revealed thirteen that met the criteria. Seven studies examined the association between Bill C-51 and suicide rates and found that while rates of suicide by firearm appeared to have declined in association with regulations, there appears to be a substitution effect into other methods and no overall change in suicide rates. Six studies examining the effects of Bill C-17 and C-68 revealed a decrease in the rates of suicide by firearms, with a corresponding increase in non-firearms suicide rates and no decrease in overall suicide rates. One study even suggested no associated decrease in firearm suicide rates with an increasing rate of suicide by hanging possibly due to changes in preferences. These results suggest legislation has mixed effects on firearm suicide rates and may not alone reduce overall suicide in Canada.

🇨🇦 Exner-Cortens, D., Baker, E., Gray, S., Van Bavel, M., Ramirez Rivera, R., Vezina, E., Ambrose, A., Pawluk, C., Schwartz, K., & Arnold, P. (2021). School-based suicide risk assessment using eHealth for youth: Systematic scoping review. JMIR Mental Health, 8(9), e29454. DOI:10.2196/29454
eHealth is a growth area for the provision of health care. This is a Canadian review looking at this medium for delivery of school-based suicide risk assessment for youth.

Abstract – Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature—consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former’s focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth.

Sabrinskas, R., Hamilton, B., Daniel, C., & Oliffe, J. (2021). Suicide by hanging: A scoping review. International Journal of Mental Health Nursing. DOI: 10.1111/inm.12956
A scoping review of a worrying trend, especially among young females, in choosing this particularly lethal method of suicide.

Abstract – Suicide by hanging is increasing in many countries around the world and whilst efforts are being made to influence the prevention agenda to reduce the incidence, little is known regarding the contributing factors for choosing this method. The purpose of this scoping review is to summate understandings about how the epidemiology and prevention of suicide by hanging is recognised, described, and discussed in the literature, and critically appraise the extent to which the lived-experiences of survivors of suicide attempts are included. A scoping review was conducted implementing the appropriate framework and in accord with the PRIMSA-ScR extension. Three databases (CINAHL, PubMed, and PsycINFO) were searched along with the reference lists of eligible sources in January and February 2021. Thirty-six articles with a primary focus on hanging as a method of suicide and/or its prevention are included in this review, with brief thematic analysis used to summarise the featured studies. Three distinct themes emerging from the literature include: (i) Hanging suicide deaths in the community environment or person’s usual place of residence, (ii) Hanging suicide deaths in controlled environments (including police cells, prisons, and inpatient units), and (iii) Medical management of near-lethal hangings. This review highlights the necessity for improving education and policy regarding the controlled environments frequently associated with hanging suicides and the medical management of near-lethal hangings, as well as the ongoing need for policy to guide and govern the responsible media portrayal of known suicides as well as fictional hangings. Finally, this review highlights the necessity for including those with lived-experiences of a suicide attempt by hanging to advance the current prevention agenda.

🇨🇦 Graham, S., Stelkia, S., Wieman, C., & Adams, E. (2021). Mental health interventions for First Nations, Inuit, and Metis peoples in Canada: A systematic review. The International Indigenous Policy Journal, 12(2). DOI: 10.18584/iipj.2021.12.2.10820
The key components of mental health interventions for First Nations, Inuit, and Metis people in Canada are examined. 14 studies are included in this systematic review.

Abstract – Higher rates of anxiety, depression, and attempted suicide are reported among First Nations, Inuit, and Métis people compared with non-Indigenous people in Canada. This systematic review summarises the key components of mental health interventions among Indigenous Peoples in Canada. We searched MEDLINE, PubMed, PsycINFO, and Web of Science between January 1,1970, and August 30, 2019. Studies needed to be an intervention addressing suicide, depression, or anxiety. There were 14 studies: 8 quantitative, 2 qualitative, and 4 mixed methods. By geographical location, 5 were urban, 5 non-urban, and 4 included multiple areas. Beneficial interventions included ceremony, being on the land, engaging in traditional food gathering, culturally grounded indoor and outdoor activities, and the sharing of Indigenous knowledge by Elders.

Tijani, B., Falana Nwaeze, J., Jin, X., & Osei-Kyei, R. (2021). Suicide in the construction industry. International Journal of Construction Management. DOI: 10.1080/15623599.2021.2005897
This systematic review looks at 28 studies on suicide in the construction industry from 1992 to 2021.

Abstract – Urgent needs to tackle the pervasiveness of suicide in the construction industry due to economic and social consequences sparked burst in literature to address the root causes and intervention for suicide. To comprehend the current state of art of suicide in the construction industry, systematic review becomes the viable option. Despite this, there is scanty study on systematic review of suicide in the construction industry. Therefore, this paper aims to systematically review 28 extant studies on suicide in the construction industry from 1992 to 2021 (years inclusive) to reveal the current state of art in the subject area. The study deduced that previous studies focused on risk factors for suicide, economic cost of suicide and suicide interventions in the construction industry. Theoretically, the findings contribute to the body of literature by revealing the limitation in the identified risk factors for suicide, economic cost of suicide and suicide intervention to unpack future studies on suicide risk factors, optimum investment in suicide and theoretical model on relationships between suicide risk, suicide interventions and suicide in the construction industry. To the practitioners, the identified risk factors can be used to develop psychosocial risk management for suicide, economic cost to determine the optimum financial investment for suicide prevention and suicide interventions to reduce suicide rate among construction workers.

🇨🇦 Ranahan, P. & Keefe, V. (2021). The bounds of suicide talk: Implications for qualitative suicide research. Health. DOI: 10.1177/13634593211060767
The authors conducted a focused ethnographic study on a small community in British Columbia. It was one of the sites for the implementation of a province wide suicide prevention gatekeeper training initiative which ran from 2015 to 2018. This study centered on the post-initiative context and the effects of the trainings within the community.

Abstract – Following the implementation of a provincial suicide prevention gatekeeper training initiative in western Canada between 2015 and 2018, we conducted a focused ethnography designed to capture the post-initiative context within one small community. Analyses of our field observations and interviews with community members suggest suicide prevention work is represented in multiple informal or coordinated actions to generate innovative pathways to provoke open conversations about suicide. Simultaneously, suicide talk is constrained and managed to limit vulnerability and exposure and adhere to community privacy norms. Further, parameters around suicide talk may be employed in efforts to construct the community and mental health care in livable ways. As the research process paralleled existing representations of suicide prevention work in the community, this paper explores our entanglement in the bounds of suicide talk during phases of recruitment, data collection and knowledge translation activities.

Burcheson, K. & Salvatore, T. (2021). Elder suicide. What senior care pharmacists need to know. The Senior Care Pharmacist, 36(11), 568-572.
A commentary proposing that a gap in older adult suicide prevention could be filled by senior care pharmacists with suicide prevention training and education.

Abstract – Older individual suicide is a growing community health problem in the United States. It is also preventable, and senior care pharmacists can increase awareness of the prevalence of suicide risk in older patients. Despite high exposure to many serious suicide risk factors and a high rate of suicide mortality, older people tend to be overlooked in suicide prevention efforts that lean mostly toward younger age groups. Senior care pharmacists can help remedy this situation by monitoring reports on older patients for possible signs of suicidality, alerting the care team if signs of potential suicide risk are present, and adding suicide prevention information to their education and counseling roles. An understanding of the nature of older individual suicide, the warning and danger signs of suicidality in older people and how and when to respond is needed. Providing this background would assure that senior care pharmacists have the skills and confidence necessary to embed suicide prevention in their practice.

🇨🇦 Oliffe, J., et al. (2021). Segmenting or summing the parts? A scoping review of male suicide research in Canada. The Canadian Journal of Psychiatry, 66(5), 433-445. DOI: 10.1177/07067437211000631
This Canadian scoping review looks at the research addressing suicide risk among male sub-groups (sexual minorities, Indigenous men, middle-aged males and men in the military).

Abstract – Objective: Suicide in Canadian men is high and rising. Research consistently indicates increased suicide risk in male subgroups including sexual minority, Indigenous, middle-aged, and military men. The current scoping review addresses the research question: Among male subgroups featured in Canadian suicide research, what are the key findings to inform suicide prevention efforts? Method: A scoping review was undertaken in accord with PRISMA-ScR guidelines. Structured searches were conducted in CIHAHL, Medline, PsychInfo, and Web of Science to identify studies reporting suicidality (suicidal ideation, plans and/or attempts) and suicide among men in Canada. Inclusion criteria comprised primary empirical studies featuring Canadian male subgroups published in English from 2009 to 2020 inclusive. Results: Sixty-eight articles met the inclusion criteria, highlighting significant rates of male suicidality and/or suicide in 3 categories: (1) health inequities (n = 29); (2) age-specific (n = 30); and (3) occupation (n = 9). The health inequities category included sexual minority men, Indigenous, and other marginalized males (i.e., homeless, immigrant men, and men who use opiates). Age-specific men focused on adolescents and youth, and middle-aged and older males. Active military, veterans, and first responders featured in the occupation category. Studies compared at risk male subgroups to females, general male populations, and/or other marginalized groups in emphasizing mental health disparities and increased suicide risk. Some men’s suboptimal connections to existing mental health care services were also highlighted. Conclusion: While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientating clinicians to the potential for men’s mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among activate military, veterans, and first responder males.

Cwik, M., Doty, S., Hinton, A., Goklish, N., Ivanich, J., Hill, K., Lee, A., Tingey, L., & Craig, M. (2021). Community perspectives on social influences on suicide within a Native American reservation. Qualitative Health Research. DOI: 10.1177/10497323211045646
The suicide rate of the Indigenous population for ages 15 to 24 in the United States is three times higher than the general population of the same age range. This study looks at social factors that contribute to these rates.

Abstract – Relative to the general population, Native Americans (NA) bear a disproportionate burden of suicide-related mortality rates. NA males and females aged 15 to 24 years experience suicide rates nearly 3 times than the U.S. all races rates in this age group. Although efforts have been made to understand and reduce suicide in tribal communities, a large portion has focused on individual characteristics with less attention given to social factors that may also inform suicide. This article aims to build on a local conceptual model of NA youth suicide by examining additional potential social factors through qualitative interviews. Findings from the thematic analysis resulted in the identification of seven perceived social influences: contagion, violence and abuse, discrimination and bullying, negative expectations, spirituality, social support, and cultural strengths. Public health approaches to reduce suicide should consider local social factors that resonate with tribal communities to build resilience.

Price, M. & Green, A. (2021). Association of gender identity acceptance with fewer suicide attempts among transgender and nonbinary youth. Transgender Health. DOI: 10.1089/trgh.2021.0079
Data from a 2018 survey of LGBTQ youth are culled to determine the association between gender acceptance from others and attempted suicide among transgender and non-binary (TGNB) youth.

Abstract – Purpose: Transgender and nonbinary (TGNB) youth report more than four times greater rates of suicide attempts compared with their cisgender peers. Gender identity acceptance from others can reduce the risk for these youth. Methods: Using data from a 2018 cross-sectional survey of LGBTQ youth, the current study examined the association of gender identity acceptance from others with suicide attempts among 8218 TGNB youth. Youth reported gender identity acceptance levels from parents, other relatives, school professionals, health care professionals, friends, and classmates to whom they were “out.” Results: Each category of adult and peer gender identity acceptance was associated with lower odds of a past-year suicide attempt, with the strongest associations within each individual category being acceptance from parents (adjusted odds ratio [aOR]=0.57) and other family members (aOR=0.51). The TGNB youth who reported gender identity acceptance from at least one adult had one-third lower odds of reporting a past-year suicide attempt (aOR=0.67), and acceptance from at least one peer was also associated with lower odds of a past-year suicide attempt (aOR=0.66). Peer acceptance was particularly impactful for transgender youth (aOR=0.47). The relationship between adult and peer acceptance remained significant after controlling for the association of each form, suggesting unique relationships for each on TGNB youth suicide attempts. Acceptance was more impactful for TGNB youth assigned male at birth compared with TGNB youth assigned female at birth. Conclusion: Interventions aimed at suicide prevention for TGNB youth should include efforts aimed at leveraging gender identity acceptance from supportive adults and peers in their lives.

Potter, J. (2021). Is suicide the unforgivable sin? Understanding suicide, stigma, and salvation through two Christian perspectives. Religions,12 (11). DOI: 10.3390/rel12110987
This paper explains theological views of suicide, both historical and current, from Catholic and protestant perspectives.

Abstract – Is suicide the unforgivable sin? Most Western arguments against suicide stem from Christian arguments. Christianity has a long-standing position that suicide is morally wrong. However, on the issue of suicide and salvation, Christianity is divided. Debate, discussion, and interpretation through the centuries have led to two different positions. This result has divided the Christian community in multiple ways. These beliefs have likely impacted the level of stigma associated with suicide losses, suicide attempts, and suicide survivors within Christianity. The stigma of suicide can be lethal if it is not properly addressed. Stigma can easily push people away from caring communities of support and from God. This paper examines the two predominate Christian theological positions on suicide and highlights areas where stigma has hindered help, support, and care. Lowering the negative effects of suicidal stigma is a foundational piece of the solution for communities of faith to engage people at risk of suicide.

🇨🇦 Chan, E., Wallace, K., Yang, E., Roper, L., Aryal, G., Lodhi, R., Baskys, A., Isenberg, R., Carnes, R., Green, B., & Aitchison, K. (2021). Internal consistency and concurrent validity of self-report components of a new instrument for the assessment of suicidality, the Suicide Ideation and Behavior Assessment Tool (SIBAT). Psychiatry Research, 304. DOI: 10.1016/j.psychres.2021.114128
This is a Canadian study measuring self-report components of the Suicide Ideation and Behavior Assessment Tool (SIBAT) and validation using the Mini International Neuropsychiatric Interview (MINI).

Abstract – This study aimed to assess the internal consistency of self-report components of the Suicide Ideation and Behavior Assessment Tool (SIBAT) and validate it with relevant elements of the Mini International Neuropsychiatric Interview (MINI). The SIBAT is a newly developed instrument for the evaluation of suicidality. In this study, we invited university students and trainees participating in a study of addictions to complete the self-report component of the SIBAT as an add-on study. We evaluated the internal consistency of the self-report component of the SIBAT and validated it against the suicidality component of the MINI. Data were analysed using both complete case analysis and multiple imputation. SIBAT data were collected for 394 participants, 314 of whom had also completed the MINI. The internal consistency of modules 2, 3, and 5 of the SIBAT was high. Each item from module 5 had a statistically significant association with the corresponding item from the MINI. The sum of scores from modules 2 and 3 had a moderate correlation with the assessment of suicide risk determined by the MINI, and a strong correlation with the total score of SIBAT module 5. The completion median time of modules 2, 3 and 5 was 14.3 min.

Braun, M., Till, B., Pirkis, J., Niederkrotenthaler, T. (2021). Effects of suicide prevention videos developed by and targeting adolescents: A randomized controlled trial. European Child & Adolescent Psychiatry. DOI: 10.1007/s00787-021-01911-6
A randomized controlled trial (RCT) testing the efficacy of positive messaging in suicide prevention videos. Suicide prevention videos with messages of hope and recovery were shown to one cohort of 14- to 19-year-olds, while a control video containing no mental health messaging was shown to another group of 14- to 19-year-olds.

Abstract – Suicide prevention videos featuring young people’s personal narratives of hope and recovery are increasingly used in suicide prevention, but research on their effects is scarce. A double-blind randomized controlled trial was conducted to test the effects of a suicide prevention video featuring an adolescent mastering his suicidal ideation by getting help on 14 to 19-year-olds. N=299 adolescents were randomly allocated to watch the intervention video (n=148) or a control video unrelated to mental health (n=151). Questionnaire data were collected before (T1) and immediately after exposure (T2), and 4 weeks later (T3). Data were analyzed with a repeated-measures ANCOVA. The primary outcome was suicidal ideation, assessed with the Reasons for Living Inventory for Adolescents. Secondary outcomes were help-seeking intentions, attitudes towards suicide, stigmatization of suicidality, and mood. There was an immediate beneficial effect of the intervention on suicidal ideation (T2 mean change from baseline within intervention group MChange=−0.16 [95% CI −0.20 to −0.12], mean difference compared to control group MDif=−0.09 [95% CI −0.15 to −0.03], ηp 2=0.03), which was not maintained at T3. Participants reported signifcantly higher help-seeking intentions, which was maintained at 4-week follow-up. They also reported a sustained reduction of favorable attitudes to suicide. Effects on suicidal ideation were mediated by identification with the featured protagonist. Adolescents appear to benefit from suicide prevention narratives featuring personal stories from peers on coping with suicidal ideation and help-seeking.

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