Research Roundup – November 2023
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month.
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Sharp, P., et al. (2023). “Hey Amir, how are you really doing?”: Participant perspectives of a peer-based suicide prevention campaign for men. American Journal of Men’s Health. https://doi.org/10.1177/15579883231209189
This is a qualitative and quantitative study of Buddy Up, a peer-based men’s suicide prevention campaign developed by Centre for Suicide Prevention. Both online surveys and interviews with individual participants informed the study.
Abstract – Suicide is a major public health concern and leading cause of death among men in Canada. This study reports the feasibility and acceptability of Buddy Up, a peer-based suicide prevention campaign for men. A mixed-methods approach was used to analyze respondent survey questionnaires (n = 48) and individual participant interviews (n = 19) collected from campaign users. Survey respondents reported that they enjoyed their involvement in the campaign (92%), were more confident to talk with men about mental health and suicide (95%) and would recommend Buddy Up to others (95%). Qualitative interviews were thematically analyzed to develop three inductively derived themes: (a) Engaging men with relatable masculine content and design: “Buddy Up really spoke to them in their language,” highlighting the importance of understanding and working with gendered practices and motivations to legitimize and motivate involvement in suicide prevention; (b) Leveraging campaign participation to initiate conversations and promote mental health: “It gives men language and license to start asking questions,” revealing ways in which participants utilized Buddy Up to negotiate and norm checking-in to promote men’s mental health; and (c) Driving new masculine cultures: “We start every meeting with a mental health moment,” identifying how participants fostered healthy milieus for disclosing mental health challenges with teamwork and preventive action under the banner of Buddy Up. The study findings support the feasibility of Buddy Up and highlight the acceptability of peer-based approaches to mental health promotion. The findings can also empirically guide future efforts for systematically building men’s peer-based suicide prevention programs.
Lindsay, B. & Szeto, A. (2023). The influence of media on the stigma of suicide when a postsecondary student dies by suicide. Archives of Suicide Research. 27(4), 1278–1295. https://doi.org/10.1080/13811118.2022.2121672
The effects of postsecondary media articles on stigma toward suicide were examined in this study. 425 undergraduate students at the University of Calgary participated.
Abstract – This study investigated whether media articles from a postsecondary institution could influence students’ stigma toward suicide after a student dies by suicide. Undergraduate participants (N = 425) read a fictitious scenario about a student suicide and were randomly assigned to a control article (no mention of the suicide) or one of three intervention articles that acknowledged the suicide and included a discussion with a psychologist, a friend of the decedent, or a suicide survivor. The stigma toward suicide survivors, particularly stereotypes, was significantly less after the three intervention articles compared to the control. No differences were found between the intervention articles or regarding the stigma toward suicide decedents. Reduced stigma toward survivors indicates that acknowledging a suicide, when possible, should be considered.
Virk, P. et al. (2023). Chronic physical conditions and suicidal ideation: A population-level analysis of Canadian school-attending young adults. Journal of Mental Health. https://doi.org/10.1080/09638237.2023.2245904
In this study out of the University of British Columbia, data from the 2012-2013 Canadian Community Health Survey (CCHS-MH) were used to compare the prevalence of suicidal ideation among school-attending young adults with and without a chronic physical condition.
Abstract – Background: Students who identify with a chronic physical condition are a growing population and their conditions may be associated with poor mental well-being. Aim: To compare suicidal ideation prevalence between Canadian school-attending young adults with and without a chronic physical condition. We hypothesized that students living with a chronic condition have a higher likelihood of experiencing suicidal ideation. Methods: A cross-sectional study was conducted using a nationally representative sample of 2297 Canadian school-attending young adults (ages 15-29 years) from the 2012-13 Canadian Community Health Survey—Mental Health (CCHS-MH). Survey-weighted logistic regression and sensitivity analyses were performed to estimate the likelihood of experiencing suicidal ideation between students with and without a chronic physical condition. Results: Approximately 14.3% (n = 329) students experienced suicidal ideation at some point. Students living with a physical chronic condition demonstrated 1.65 (95% CI: 1.14, 2.39) times higher odds of experiencing suicidal ideation, compared to students not living with a chronic physical condition. Conclusions: Suicide prevention and health promotion are important considerations for campus health providers and administrators when planning services and accommodations for students living with chronic physical conditions.
Gryglewicz, K. et al. (2023). Examining individual and service delivery context variables and their association with the effectiveness of QPR suicide prevention gatekeeper training. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-023-01308-4
In this study, Question, Persuade and Refer (QPR), a suicide prevention gatekeeper training, was examined for training outcomes among different child and public-serving delivery sectors. Participants included community support personnel, workers in juvenile justice, and child welfare workers.
Abstract – Suicide prevention training programs have spread rapidly within child and public-serving organizations, due to the alarming increase in youth suicide rates. Yet, within these organizations, roles and responsibilities can shape attitudes and intentions related to suicide prevention, thereby influencing the uptake of prevention efforts. As such, various organizational and individual factors can predict uptake, adoption, and maintenance of prevention efforts (Fixsen et al., 2005). To date, few studies have examined the service delivery context in understanding training effectiveness, especially as it relates to QPR (Question Persuade and Refer), one of the most widely disseminated suicide prevention gatekeeper programs. The purpose of this longitudinal study was to evaluate whether individual and organizational characteristics influenced the effectiveness and sustainability of training outcomes, and whether such differences existed among diverse child and public-serving delivery sectors. Several training outcomes that align with the Theory of Planned Behavior (Ajzen, 1991) were examined, including confidence, attitudes, social norms, and suicide prevention behaviors. Measures were assessed prior to and 90 days after the QPR program among a sample of 858 professionals. Community support personnel uniquely showed improvements on social norms while juvenile justice and child welfare workers engaged in more suicide prevention behaviors post training. While trainees across sectors had improved suicide prevention attitudes, law enforcement personnel were the exception. Organizational climate predicted change in suicide prevention attitudes, confidence, and social norms. Trainees who were older, Latinx, and Black had the most improvement on several training outcome variables, but these findings also varied within service sectors.
Spafford, S.G. et al. (2023). Mental wellbeing and resilience in suicide prevention crisis line volunteers. Community Mental Health Journal. 59, 1562–1567. https://doi.org/10.1007/s10597-023-01143-9
The mental wellbeing and resiliency of crisis line volunteers was examined in this longitudinal study. 20 crisis line volunteers were surveyed at the outset of the training, at 3 months, and then again at 6 months. Some of the areas measured included, “mental wellbeing, resilience, support, help-seeking, and other related personal and professional factors”.
Abstract – Crisis line volunteers are critical to nationwide suicide prevention efforts as they provide free support services to those experiencing emotional distress or suicidality. Most crisis lines rely on volunteers for call-taking, however, the experiences of these volunteers and the impact of call-taking on their mental wellbeing remains understudied. The current study aimed to explore mental wellbeing and resilience in suicide prevention crisis line volunteers. In a longitudinal study among 20 volunteers of a suicide prevention crisis line, participants completed a series of three surveys at baseline, 3-month, and 6-month follow-up, measuring mental wellbeing, resilience, support, help-seeking, and other related personal and professional factors, including compassion satisfaction, burnout, and secondary traumatic stress. Results indicated that self-rated mental health was positively associated with willingness to seek help for an emotional problem from a doctor. Additionally, social support was negatively associated with burnout, but positively associated with compassion satisfaction. Finally, preparedness was negatively associated with secondary traumatic stress, while seeking help for an emotional problem or suicidality from a parent were both positively associated with secondary traumatic stress. Crisis line volunteers rated their mental health and compassion satisfaction highly and reported low levels of burnout and secondary traumatic stress. The role of social support and preparedness for call-taking deserve further investigation by researchers and crisis call centers as they may be critical to responders’ wellbeing.
Purc-Stephenson, R. et al. (2023). Understanding the factors contributing to farmer suicide: A meta-synthesis of qualitative research. Rural and Remote Health. https://doi.org/10.22605/RRH8189.
This is a review of 14 studies examining farmer suicide. The authors aimed to uncover themes and patterns specific to farmers.
Abstract – Introduction: Farming is associated with a range of ongoing occupational stressors that place farmers at an elevated risk for suicide. The increase of farmer suicide in recent years represents an important public health concern and requires an understanding of the circumstances and risk factors that contributed to a farmer’s decision to die by suicide, as well as the protective factors that can help farmers manage the stressors. Qualitative research examining farmer suicide has grown in recent years and provides a rich description of the farmers’ lives leading up to their suicide that cannot be easily captured from quantitative surveys. Therefore, we conducted a systematic review and meta-synthesis to understand the risk and protective factors preceding the farmers’ suicide from the perspectives of their partner, relatives, or individuals who worked closely with them. We used this information to generate a conceptual model to illustrate the intersecting nature of farm culture, work-life stressors and mental health. Methods: We conducted a comprehensive literature search for peer-reviewed studies using electronic databases Embase, PsycINFO, Academic Search Complete, PubMed and Scopus using a combination of search terms related to farming and suicide. All searching was conducted by two independent researchers. The selected studies were critically appraised using standardized forms to assess study quality. The qualitative data from each study was analyzed using meta-ethnography to identify underlying themes related to suicide and new interpretations of the topic while retaining the original meaning of each qualitative study. Results: After independently screening studies, our final sample included 14 studies. We identified seven themes that contributed to farmer suicide: maintaining a ‘farmer’ identity, financial crisis, support and stress of family, the community panopticon, isolation from others, access to toxins and firearms, and an unpredictable environment. Using these themes, we developed a conceptual model called the Farming Adversity-Resilience Management framework (ie FARM framework) to highlight the cyclical and dynamic pattern of farm culture and to illustrate the risk factors that contribute to vulnerability to poor mental health and even suicide. This model also identifies a variety of protective factors that can improve farmers’ resilience to such stressors. Conclusion: This is the first study to synthesize qualitative data about farmer suicide. While the enduring challenges and stressors of farming in rural areas may never be eliminated, there may be ways to help farmers build resilience to these factors. Our FARM framework presents a new way of understanding farm culture, the occupational stressors and farmers’ wellbeing while also providing direction for future research and guidance for practical interventions. Policymakers and healthcare providers should consider developing and delivering mental health literacy programs to farmers and those who work closely with them to identify symptoms of poor mental health and to facilitate attitude change. Greater access to health care should be a priority in rural areas, and clinicians should be familiar with the stressors farmers face so that they can ask questions about their work-life balance to better assess the farmer’s mental health and risk of suicide.
Stack, S. (2023). Suicide among roofers: Injury, pain & substance misuse. Archives of Suicide Research. https://doi.org/10.1080/13811118.2023.2262535
The construction industry has high rates of suicide. Renowned American suicidologist Steven Stack and team drew on data from the National Violent Death Reporting System (NVDRS) in the United States to investigate contributing factors to the suicides of roofers, a subset of construction workers.
Abstract – Objective: CDC has called for suicide research on the construction industry, an industry with a high suicide rate. The present study addresses this gap and focuses on roofers. It assesses which risk factors distinguish suicides by roofers from those of the general population. Alcohol and drug misuse, related to their high incidence of injury and pain, are seen as key potential drivers of roofer suicide. Methodology: Data refer to 30,570 suicides and are taken from the National Violent Death Reporting System (NVDRS). Drawing from previous work on the health professions, 15 core predictors are selected, representing psychiatric morbidity, social strains, and demographics. Since the analysis seeks to differentiate roofers’ suicides from others, the dependent variable is a dichotomy where roofers’ suicides (=1) and other suicides (=0). Results: After adjusting for the other 14 risk factors, a multivariate logistic regression analysis found that roofers’ suicides were 76% more apt (Odds ratio = 1.76, CI: 1.18, 2.63) than other suicides to have a known substance or alcohol problem that contributed to their suicide. Other constructs differentiating roofers’ suicides from other suicides included marital status, gender, and race. Roofers were less protected by marriage. Conclusion: The results inform prevention efforts and substance misuse can serve as a key warning sign for roofers’ suicide. This is the first investigation of the drivers of suicide among roofers, and one of a few drawing links between occupational injury and suicide.
Aspin, C. et al. (2023). Engaging with whānau to improve coronial investigations into rangatahi suicide. Kotuiui: New Zealand Journal of Social Sciences Online. https://doi.org/10.1080/1177083X.2023.2270007
Researchers in New Zealand look at the practices of coroners into the suicide investigations of Indigenous Maori youth. They ask if these coronial investigations meet the needs of Maori bereaved by suicide?
Abstract – This article reports the findings of two studies of the Aotearoa coronial service that sought to understand how coronial processes engage with whānau who have lost a rangatahi to suicide. The aim of the combined study was to understand the extent to which coronial investigations met the needs of Māori bereaved by suicide. We conducted interviews with coroners to understand how they investigate suicide (Study One) and examined coronial files of rangatahi who had died by suicide, including communications between the coroner’s office and the bereaved whānau (Study Two). We found that coroners relied heavily on documentation and only rarely engaged with whānau to gather evidence from those who knew the person who died by suspected suicide. Moreover, forms of communication between the coronial service and whānau were couched in legalese and did not engage with whānau in ways that would add value to the coronial investigation and lead to closure for bereaved whānau. Current efforts to embed Te Tiriti o Waitangi in government policy provide an ideal opportunity to adopt a Tiriti-based approach to coronial investigations so that they align with the needs of whānau in ways that contribute to culturally appropriate suicide investigation, suicide prevention and postvention initiatives.
Hawke, L. et al. (2023). Medical Assistance in Dying for mental illness as a sole underlying medical condition and its relationship to suicide: A qualitative lived-experience-engaged study. Canadian Journal of Psychiatry. https://doi.org/10.1177/07067437231209658
30 individuals with mental illness and 25 family members of those with mental illness were interviewed to gauge their perspectives on the relationship between MAiD MI-SUMC (medical assistance in dying for mental illness as a sole underlying medical condition) and suicide.
Abstract – Objective: This lived experience-engaged study aims to understand patient and family perspectives on the relationship between suicidality and medical assistance in dying when the sole underlying medical condition is mental illness (MAiD MI-SUMC). Method: Thirty individuals with mental illness (age M = 41.8 years, SD = 14.2) and 25 family members (age M = 47.5 years, SD = 16.0) participated in qualitative interviews examining perspectives on MAiD MI-SUMC and its relationship with suicide. Audio recordings were transcribed and analysed using reflexive thematic analysis. People with lived experience were engaged in the research process as team members. Results: Four main themes were developed, which were consistent across individuals with mental illness and family members: (a) deciding to die is an individual choice to end the ongoing intolerable suffering of people with mental illness; (b) MAiD MI-SUMC is the same as suicide because the end result is death, although suicide can be more impulsive; (c) MAiD MI-SUMC is a humane, dignified, safe, nonstigmatized alternative to suicide; and (4) suicidality should be considered when MAiD MI-SUMC is requested, but suicidality’s role is multifaceted given its diverse manifestations. Conclusion: For patient-oriented mental health policy and treatment, it is critical that the voices of people with lived experience be heard on the issue of MAiD MI-SUMC. Given the important intersections between MAiD MI-SUMC and suicidality and the context of suicide prevention, the role that suicidality should play in MAiD MI-SUMC is multifaceted. Future research and policy development are required to ensure that patient and family perspectives guide the development and implementation of MAiD MI-SUMC policy and practice.
Coppersmith et al. (2023). Mapping the timescale of suicidal thinking. Psychological and Cognitive Sciences. https://doi.org/10.1073/pnas.2215434120
The authors analyze suicidal thoughts and behaviours in this study. They take a particular interest in the duration of elevated levels of suicidal thinking.
Abstract – This study aims to identify the timescale of suicidal thinking, leveraging real-time monitoring data and a number of different analytic approaches. Participants were 105 adults with past week suicidal thoughts who completed a 42-d real-time monitoring study (total number of observations = 20,255). Participants completed two forms of real-time assessments: traditional real-time assessments (spaced hours apart each day) and high-frequency assessments (spaced 10 min apart over 1 h). We found that suicidal thinking changes rapidly. Both descriptive statistics and Markov-switching models indicated that elevated states of suicidal thinking lasted on average 1 to 3 h. Individuals exhibited heterogeneity in how often and for how long they reported elevated suicidal thinking, and our analyses suggest that different aspects of suicidal thinking operated on different timescales. Continuous-time autoregressive models suggest that current suicidal intent is predictive of future intent levels for 2 to 3 h, while current suicidal desire is predictive of future suicidal desire levels for 20 h. Multiple models found that elevated suicidal intent has on average shorter duration than elevated suicidal desire. Finally, inferences about the within-person dynamics of suicidal thinking on the basis of statistical modeling were shown to depend on the frequency at which data was sampled. For example, traditional real-time assessments estimated the duration of severe suicidal states of suicidal desire as 9.5 h, whereas the high-frequency assessments shifted the estimated duration to 1.4 h.
Elliott, E. & Bang, M. (2023). Reducing Indigenous suicide: Recognizing vital land and food systems for livelihoods. American Journal of Community Psychology. https://doi.org/10.1002/ajcp.12712
This qualitative study looks at the impacts colonialism has had and continues to have on suicide in some Indigenous communities.
Abstract – Colonial trauma poses a significant risk to the physical, intellectual, and mental health of Indigenous youth and young adults. Education and mental health scholars are increasingly concerned about the emotional wellbeing of young people, particularly as rates of suicide have increased across the United States. With interest in identifying the unique contextual dynamics involved in understanding Indigenous suicide, this work considers characteristics related to colonialism that may uncover strategies for both educators and mental health practitioners that address disparities. Drawing on a larger ethnographic study, this inquiry asks how settler encroachment upon Indigenous land and food systems is related to death by suicide from the perspective of Cowichan Tribes members. Comprehensive semi-structured interviews were conducted (n = 21); each interview was audio-recorded and transcribed verbatim. Data were analyzed deductively based upon a priori suppositions related to settler colonial theory. Cowichan members’ narrated explanations for suicide rooted in disruptions to (1) relationships with the land and (2) traditional food systems. They described how settler encroachment infringed upon their subsistence way of living and introduced incongruent constructions of nature-culture relations (e.g., humans as distinct and separate from the natural world). Settler futurity is secured through the arrogation of territorial dominance coupled with physical or conceptual acts of erasure, placing Indigenous lives and lifeways at risk. One outcome of the disruption to Indigenous collective capacities is a dramatic increase in Indigenous suicide.
Bolanis, D. et al. (2024). Association between greenspace exposure and suicide-related outcomes across the lifespan: A systematic review. Science of The Total Environment. https://doi.org/10.1016/j.scitotenv.2023.167451
This is a systematic review of 23 studies looking at the protective association between exposure to greenspace and suicide-related outcomes.
Abstract – A growing number of studies have linked greenspace exposure to suicide, but findings are inconsistent. We conducted a systematic review on the associations between greenspace exposure and suicide-related outcomes (namely, suicide mortality, self-harm, and suicidal ideation) up until January 6, 2023. We used the Mixed Methods Appraisal Tool (or MMAT) to assess the quality of the included studies. In total, 23 studies met our inclusion criteria, consisting of 14 ecological, four cross-sectional, three longitudinal, and two experimental studies. Most studies were published in 2022 and conducted in Europe (n = 10), Asia (n = 7), and North America (n = 5), with one worldwide analysis. Various indicators were used to assess greenspace exposure including objective measures (e.g., level of surrounding greenness, quantity, structural features, tree canopy coverage), and greenspace use (e.g., duration and frequency). Suicide mortality was the most studied outcome (n = 14). Quality assessment showed that most (87 %) of the included observational studies used representative samples. Protective associations of exposure to greenspace were reported for suicide mortality (9/14 or 64 %), self-harm (n = 3/5 or 60 %) and suicidal ideation (n = 4/6 or 67 %), with nine or 36 % studies reporting no association. Most of the included studies adjusted for key covariates such as age, sex, and socioeconomic status at various aggregate levels (e.g., household, city). For greenspace exposure and suicide mortality, studies stratified by sex (n = 10) showed larger protective associations for females (n = 7) than for males (n = 4). However, the included studies showed high heterogeneity in terms of exposure indicators and greenspace definitions. Experimental studies and studies using youth samples were rare. While more research is warranted, preliminary findings suggest protective associations between greenspace exposure and suicide-related outcomes.