Research Roundup – October 2021
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month:
Berona, J., Whitton, S., Newcomb, M. Mustanski, B. & Gibbons, R. (2021). Predicting the transition from suicidal ideation to suicide attempt among sexual and gender minority youths. Psychiatric Services, 72(11), 1261-1267. DOI: 10.1176/appi.ps.202000497
This is a study of suicidal ideation and attempted suicide among sexual and gender minority youths. The Computerized Adaptive Test for Suicide Scale (CAT-SS) was administered to two ongoing sexual and gender minority adolescent and young adult cohorts.
Abstract – Objective: Sexual and gender minority youths are more likely to consider, attempt, and die by suicide than are heterosexual and cisgender youths, yet little is known about how to predict future attempts or transitions from suicidal thoughts to behaviors. Additionally, adaptive measurement of psychopathology is a promising approach that may help characterize risk in this population. This study examined the validity of the Computerized Adaptive Test for Suicide Scale (CAT-SS) in predicting suicide attempts and the transition from suicidal ideation to attempt. Methods: The CAT-SS was administered to participants of two ongoing cohort studies of sexual and gender minority adolescents and young adults (N=1,006). Survival analyses examined longitudinal associations between CAT-SS scores and time to suicide attempt. Analyses were conducted for the full sample and stratified by those with and without a history of suicidal ideation, with comparisons between adaptive and static measures of depressive symptoms. Results: The CAT-SS predicted future suicide attempts in the overall sample (hazard ratio [HR]=1.34, 95% confidence interval [CI]=1.03–1.74). Among youths without a history of suicidal ideation, social support reduced the risk for attempts (HR=0.66, 95% CI=0.45–0.96). Among youths with a history of ideation, predictors of the transition from suicidal thoughts to attempts included baseline CAT-SS score (HR=1.51, 95% CI=1.06–2.15) and victimization (HR=2.48, 95% CI=1.10–5.59). Conclusions: Risk and protective factors for suicide attempts differed between youths with and without a history of suicidal thoughts. The CAT-SS had validity in predicting future risk of the sample overall and of youths with suicidal ideation.
Jacups, S.P. & Kozlowski, W. (2021). Safety planning for youth with suicide risk: A clinical audit. Australian Social Work. DOI: 10.1080/0312407X.2021.1950788
An audit with quality improvement purposes of Brown and Stanley’s Safety Planning Intervention (SPI) was conducted among 13-17 year-olds in an Australian emergency department.
Abstract – This quality improvement activity examined Safety Planning Intervention (SPI) over two 3-monthly periods for presentations from 13–17-year-olds with suicidal risk to a regional hospital Emergency Department (ED). We collected patient demography, presentation characteristics, presentation rate, and clinician use of SPI, including those under Emergency Examination Authorities (EEAs). An education workshop was offered between the audits, aimed to increase clinician (social work, psychology, nursing, and psychiatry) knowledge of SPIs. The annual ED presentation rate for suicide risk for 15–17-year-olds was 1,520 per 100,000 persons. More presentations were female, non-Indigenous persons, and fewer than half presented voluntarily. Most presentations were for suicide attempt followed by suicide threat. In the first audit clinicians initiated SPIs in fewer than 50% of cases and completed SPIs in 15%. Whereas in the second audit where SPIs were initiated by clinicians in 69% of cases and fully completed in 49%, less than half the presentations with EEAs received a completed SPI. Indigenous persons, although a lower proportion of presentations, were overrepresented for the population. Following the education workshop, there was an improvement in SPI completion, reflecting the benefits of education and training to clinical staff. Lastly, this study highlights the benefit of conducting audits as quality improvement activities for patient care.
Pergolizzi, J., Breve, F., Magnusson, P., Nalamasu, R., LeQuang, J., & Varrassi, G. (2021). Suicide by opioid: Exploring the intentionality of the act. Cureus. 13(9), e18084.
This paper explores the ongoing opioid epidemic in North America and the ambiguity surrounding opioid overdose and suicide.
Abstract – Opioid toxicity can result in life-threatening respiratory depression. Opioid-overdose mortality in the United States is high and increasing, but it is difficult to determine what proportion of those deaths might actually be suicides. The exact number of Americans who died of an opioid overdose but whose deaths might be classified as suicide remains unknown. It is important to differentiate between those who take opioids with the deliberate and unequivocal objective of committing suicide, that is, those with active intent, from those with passive intent. The passive-intent group understands the risks of opioid consumption and takes dangerous amounts, but with a more ambiguous attitude toward suicide. Thus, among decedents of opioid overdose, a large population dies by accident, whereas a small population dies intending to commit suicide; but between them exists a sub-population with equivocal intentions, waxing and waning between their desire to live and the carelessness about death. There may be a passive as well as active intent to commit suicide, but less is known about the passive motivation. It is important for public health efforts aimed at reducing both suicides and opioid-use disorder to better understand the range of motivations behind opioid-related suicides and how to combat them.
🇨🇦 Black, T. & Kutcher, S. (2021). Suicide during COVID-19: Myths, realities and lessons learned. University of British Columbia Medical Journal, 12(2), 11-13.
A commentary disputing the oft-repeated notion, found in both the academic literature and the popular press, that an increase in suicides because of the COVID-19 pandemic is inevitable.
Abstract – Suicide is a challenging health concern, as worldwide approximately 800,000 people per year die of suicide, and it ranks amongst the top causes of death in young people. Causes of suicide are multifactored and it is clear that various societal and environmental factors may affect suicide rates. This can be demonstrated by the significant variability in national suicide rates across the world, variable ratios of male-to-female suicide deaths rates, and evidence that racism against Indigenous people worldwide contributes to disproportionately higher suicide rates. The SARS-Cov-2 pandemic is a significant global challenge that, at the time of this writing, has infected 92 million people with the COVID-19 virus and caused almost 2 million deaths worldwide. While the definitive story of mental health outcomes, like many other pandemic related outcomes, has yet to be written, one narrative has to date dominated both the academic literature and popular media: the prediction of a “tsunami” of suicides during the pandemic.
🇨🇦 Ansloos, J. & Peltier, S. (2021). A question of justice: Critically researching suicide with Indigenous studies of affect, biosociality, and land-based relations. Health. DOI: 10.1177/13634593211046845
This is a paper calling for the adoption of an Indigenous lens, derived from Indigenous studies, in suicide research.
Abstract – This paper considers how Indigenous studies can inform the evolution of critical research on suicide. Aligned with critiques of mainstream suicidology, these methodological approaches provide a roadmap for structural analysis of complex systems and logics in which the phenomenon of suicide emerges. Moving beyond mere naming of social determinants of suicide and consistent with calls for a theory of justice within suicide research, Indigenous studies helps to advance conceptual knowledge of suicide in descriptive means and enhance ethical responses to suicide beyond psychocentric domains. Through centering Indigenous theories of affect, biosociality, and land-based relations, this article examines what new knowledge of suicide can emerge, as well as what ethical responses are possible to suicide and to a world where suicide exists. This new knowledge can inform practices for critical suicide studies which are invested in resisting structural violence, nourish agency, dignity and freedom for those living and dying in often-unlivable presents, and enhancing livability for individuals, communities, and the environment living under shadows of empire. Implications for theory, ethics, and suicide research and prevention practice are considered.
King, K., Krysinska, K., & Nicholas, A. (2021). A rapid review to determine the suicide risk of separated men and the effectiveness of targeted suicide prevention interventions. Advances in Mental Health. DOI: 10.1080/18387357.2021.1977666
Men who are separated from intimate relationships are an at-risk group for suicide. This review aims to capture the rates of suicidal ideation and behaviours among this group.
Abstract – Objective: This rapid review aimed to understand the rates of suicidal ideation and behaviours in men who are separated from intimate relationships, the co-occurrence of risk factors, and the effectiveness of suicide prevention interventions for them in order to inform future suicide prevention efforts. Method: The review method followed a streamlined systematic review process which facilitates an expedited review of the evidence related to the review questions. We searched three academic databases (Cochrane, Medline and PsycINFO) for peer-reviewed articles published between 2010 and 2019 in English using keywords related to men who are separated from an intimate relationship; suicidal thoughts, attempts and deaths; suicide rates; and suicide prevention interventions. Results: Four systematic reviews and 22 papers featuring primary studies were included in the review relating to suicide rates and risk. No papers were identified relating to the effectiveness of suicide prevention interventions for this group. The evidence base was rated as good. The findings suggest that men who are separated from an intimate relationship are at higher risk of suicide. Discussion: The review identified an increased risk of suicide among men who are separated, but no evidence about the effectiveness of suicide prevention interventions for them. More work is needed to unpack the interplay between personal and sociodemographic factors and the risk of suicide for separated men in order to inform suicide prevention efforts with these men.
Marlow, N., Xie, Z., Tanner, R., Jo, A., & Kirby, A. (2021). Association between disability and suicide-related outcomes among U.S. adults. American Journal of Preventive Medicine. DOI: 10.1016/j.amepre.2021.05.035
The authors in this study investigate the prevalence of suicidal ideation and behaviours among those with physical or intellectual disabilities.
Abstract – Introduction: Although research has analyzed the sociodemographic and socioeconomic risks for suicide, only recently has suicide risk for people with disabilities been examined. This study investigates the associations between disability and distinct suicide-related outcomes, including suicidal ideation, suicide planning, and suicide attempt. Methods: This nationally representative, cross-sectional study comprised secondary analyses of the 2015–2019 National Survey on Drug Use and Health conducted in 2020 (N=198,640, representing 229,556,289 U.S. adults). Disability status comprised the presence of any disability; hearing, vision, mobility, cognitive, complex activity, or ≥2 limitations; and 1, 2, 3, 4, or ≥5 limitations. Suicide-related outcomes in the past year included none, suicidal ideation only, suicide planning, and suicide attempt. Multivariable logistic regression was applied to estimate the AORs. Results: Overall, 19.8% reported any disability. Results showed that people with disabilities were significantly more likely than those without disabilities to report suicidal ideation (AOR=2.13, 95% CI=1.93, 2.36), suicide planning (AOR=2.66, 95% CI=2.27, 3.11), and suicide attempt (AOR=2.47, 95% CI=2.05, 2.98). Furthermore, individuals within each limitation count group were significantly more likely than people without disabilities to report suicide-related outcomes (p<0.001), with the largest magnitudes among those with ≥5 limitations for suicidal ideation (AOR=3.80, 95% CI=2.32, 6.23), suicide planning (AOR=6.45, 95% CI=3.52, 11.80), and suicide attempt (AOR=8.19, 95% CI=4.45, 15.07). Conclusions: People with various types of functional disabilities had an elevated risk for suicide-related outcomes, compared with people without disabilities. The more limitations a person had progressively increased their risk. These findings call for focused attention to the mental health of people with disabilities, including suicide prevention efforts that accommodate their needs.
Stanley, B., Martinez-Alex, G., Gratch, I., Rizk, M., Galfalvy, H., Choo, T., & Mann, J. (2021). Coping strategies that reduce suicidal ideation: An ecological momentary assessment study. Journal of Psychiatric Research. DOI: 10.1016/j.jpsychires.2020.12.012
Ecological momentary assessment (EMA) is used to examine the effectiveness of specific coping strategies in the reduction of suicidal ideation.
Abstract – Background: While suicide-specific psychosocial interventions often teach coping skills to suicidal individuals, little is known about the strategies that individuals intuitively use on their own to cope with suicidal ideation in everyday life. Aims: The present study used Ecological Momentary Assessment (EMA) to examine the effectiveness of specific coping strategies individuals use naturally to reduce the intensity of suicidal thinking. Method: Fifty participants endorsing suicidal ideation with co-morbid mood disorder and borderline personality disorder completed one week of EMA. Real-time use, perceived effectiveness of 7 common coping strategies and intensity of suicidal ideation were assessed at 6 epochs (i.e., timepoints) each day. Results: Participants reported using an average of 4 coping strategies per epoch. Factor analysis (FA) (exploratory followed by confirmatory FA) identified two coping factors: one that included distraction/positive activity-based strategies (i.e., keeping busy, socializing, positive thinking, and doing something good for self) and a second that contained mindfulness-oriented strategies (i.e., finding perspective, calming self, and sitting with feelings until they pass). Although participants perceived all coping strategies as effective, only strategies in the first factor, distraction/positive activity-oriented strategies, lowered the intensity of suicidal thoughts in everyday life. Furthermore, baseline suicidal ideation was inversely related to overall use of coping strategies and particularly use of coping strategies that were found to lead to lowered suicidal ideation. Conclusions: Distraction/positive activity-based strategies are helpful in decreasing suicidal ideation in the short-term. These findings can help clinicians advise patients about strategies to use to cope with suicidal thoughts to prevent acting on them in a crisis and they also have the potential to inform development of psychosocial interventions to prevent suicide.
LeCloux, M. (2021). Efficient, yet effective: Improvements in suicide-related knowledge, confidence, and preparedness after the deployment of a brief online module on suicide in a required MSW course. Journal of Teaching in Social Work, 41(4), 389-407. DOI: 10.1080/08841233.2021.1954577
This study examines the efficacy of a brief online module involving suicide risk assessment and treatment. The module is geared toward students enrolled in a master’s level social work course.
Abstract – Although social workers are increasingly likely to encounter suicidal clients in their practice, many are under-prepared to address the issue of suicide, and significant deficiencies in suicide education exist in social work graduate programs. This study examined the acceptability and effectiveness of a brief yet comprehensive online module covering suicide risk assessment and treatment deployed as part of a required master’s level social work course. Students completed online pre- and posttest surveys that measured suicide-related knowledge, perceived preparedness, and confidence, and rated various elements of the module. A total of N =53 MSW students participated in the study, of whom N = 45 completed both the pre- and posttests. Scores for suicide-related knowledge, perceived preparedness, and confidence increased significantly from pre- to posttest (p’s < .001). The majority of students (95.7%) were satisfied or highly satisfied with the overall content, comprehensiveness, and format of the module. However, most (70.2%) reported a preference for face-to-face or hybrid delivery methods for suicide-related material. Implications discussed include the use of synchronous elements to address student anxiety related to suicide-related content, the utility of pre-prepared online learning modules to address curriculum related barriers, and the importance of well-designed online materials.
Kohlbeck, S., Schramm, A., deRoon-Cassini, T., Hargarten, S., & Quinn, K.. (2021). Farmer suicide in Wisconsin: A qualitative analysis. The Journal of Rural Health. DOI: 10.1111/jrh.12622
A study of farmer suicide in Wisconsin from 2012 to 2016, culling data from the Wisconsin Violent Death Reporting System. Specific characteristics of farmer suicide are identified.
Abstract – Purpose: There is a need to address suicide among farmers in the United States and understand what contributes to suicide among American farmers. The purpose of this qualitative study is to analyze narrative data to uncover circumstances that were present in the lives of farmers who died by suicide. Methods: This study leverages data available in the National Violent Death Reporting System. For this study, we examined all suicides that occurred in Wisconsin between the years 2012 and 2016 and were extracted from the Wisconsin Violent Death Reporting System. Decedents were manually sorted by the “usual occupation” variable in order to identify farmers. Findings: During the study period, 73 farmers died, most of whom were White, non-Hispanic males. Four themes were identified in the thematic analysis: stymied by physical health issues, grief from loss of relationships, ready access to firearms in rural Wisconsin, and the burden of farming and the farm. Conclusions: The findings from this study demonstrate how unique contextual factors lead to suicide among farmers. This study has implications for suicide prevention among farmers. Primarily, there is a need to address the accessibility of firearms, as their availability in a time of crisis has lethal consequences. However, suicide prevention programming that addresses access to lethal means must take the sociocultural context of rural America into consideration. These findings should also be considered as applied to health care providers that serve rural communities. Suicide risk assessment and management should consider stressors unique to farmers.
Smith, N. & Linker, S. (2021). Suicide-memes as exemplars of the everyday inauthentic relationship with death. Mortality. DOI: 10.1080/13576275.2021.1987668
The authors explore the use of suicide-memes on social media and whether their usage may be more harmful than they may appear.
Abstract – Depictions of death in media produced for young audiences are not limited to melodramas or action films; there are frequent depictions of death in new media, often produced not only for, but also by, young adults. Despite the fact that new media in general, and memes in particular, are standard means of communication and expression for young people, memes about suicide (hereafter suicide-memes) are not thoroughly studied in their own right. This article presents a phenomenological analysis of contemporary suicide-memes. Although suicide-memes seem, on the surface, to be just gallows humour or hyperbole that has little to do with death, we argue that this is deceptive. We contend that suicide-memes are characteristic of what Heidegger calls our everyday, inauthentic relationship with death. This relationship is one of trivialisation and avoidance, which obscures the personal reality, and inevitability, of one’s own death.
🇨🇦 Lui, L., Capaldi, C., & Dopko, R.. (2021). Original quantitative research-Suicide ideation in Canada during the COVID-19 pandemic. HPCDP Journal. DOI: 10.24095/hpcdp.41.11.06
A Public Health Agency of Canada (PHAC) report on the rates of suicidal ideation observed in Canada throughout the COVID-19 pandemic. They cull data from the Survey on COVID-19 and Mental Health and the 2019 Canadian Community Health Survey to inform the report.
Abstract – Introduction: Many Canadians report decreased mental health during the COVID-19 pandemic, and concerns have been raised about possible increases in suicide. This study investigates the pandemic’s potential impact on adults’ suicide ideation. Methods: We compared self-reported suicide ideation in 2020 versus 2019 by analyzing data from the Survey on COVID-19 and Mental Health (11 September to 4 December 2020) and the 2019 Canadian Community Health Survey. Logistic regression was conducted to determine which populations were at higher risk of suicide ideation during the pandemic. Results: The percentage of adults reporting suicide ideation since the pandemic began (2.44%) was not significantly different from the percentage reporting suicide ideation in the past 12 months in 2019 (2.73%). Significant differences in the prevalence of recent suicide ideation in 2020 versus 2019 also tended to be absent in the numerous sociodemographic groups we examined. Risk factors of reporting suicide ideation during the pandemic included being under 65 years, Canadian-born or a frontline worker; reporting pandemic-related income/job loss or loneliness/isolation; experiencing a lifetime highly stressful/traumatic event; and having lower household income and educational attainment. Conclusion: Evidence of changes in suicide ideation due to the pandemic were generally not observed in this research. Continued surveillance of suicide and risk/protective factors is needed to inform suicide prevention efforts.
Ewert, R. (2021). “A country boy can survive:” Rural culture and male-targeted suicide prevention messaging. Social Science & Medicine, 289.
In this study, men, women and mental health service providers in rural California are surveyed about a male-targeted suicide prevention effort called Captain Awesome.
Abstract – The low rate of help-seeking and high rate of suicide completion among men has prompted public health officials to create suicide prevention campaigns that specifically target men. Drawing from data collected as part of a larger study of fire recovery in a rural county in Northern California, this paper utilizes 68 interviews with fire survivors (24 men and 44 women) and 40 interviews with mental health service providers to examine how rural residents interpret this type of campaign. To track patterns of help-seeking over time, I also draw upon 26 follow-up interviews – 20 with fire survivors (7 men and 13 women) and 6 with service providers – conducted one year after the first wave of interviews. In total, 134 in-depth interviews were conducted. This paper also draws on a secondary data source; I conducted content analysis of an internal Health and Human Services Agency focus group report used in the development of a local male-targeted suicide prevention campaign, Captain Awesome. As I show, male-targeted suicide prevention efforts have little salience in rural communities in which treatment resources are limited and stigma abounds. Perceptions about material conditions – i.e., treatment resources being few and far between – contribute to residents establishing a norm of not seeking help. Rural culture which emphasizes self-sufficiency and independence contributes to a pattern of both men and women repeating a narrative that frames men who seek help as weak. While research has identified women as key drivers for men’s physical health maintenance, my research suggests that the same pattern might not hold around mental health maintenance in rural settings. In sum, I argue that male-targeted campaigns have limited resonance and efficacy in rural communities where material conditions and cultural narratives create physical and psychological barriers to accessing to treatment.