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

Ackerman, J. & Horowitz, L. (Eds.). (2022). Youth Suicide Prevention and Intervention: Best Practices and Policy Implications. Springer. DOI: 10.1007/978-3-031-06127-1
This a recent open-access textbook on youth suicide. It is atypical of the usual offerings in our RRU but we felt the nature of the topic and the fact that it is open-access deemed its inclusion as essential. The book includes chapters addressing the public health crisis of youth suicide as well as suicide prevention and interventions for youth. It also examines suicide epidemiology, risk detection in school and medical settings, safety counselling and more.

🇨🇦 Mishara, B. & Fortin, L. (2022). Long-term effects of a comprehensive police suicide prevention program: 22-year follow-up. Crisis, 43(3), 183-189. DOI: 10.1027/0227-5910/a000774
A follow-up of an earlier study (2012) of a police suicide prevention program in Montreal.

Abstract – Background: Mishara and Martin (2012) reported decreases in suicides 12 years after implementation of a police suicide prevention program. Aims: We aimed to determine whether suicide decreases were sustained 10 years later. Method: We examined coroners’ investigations of police deaths from 2009 through 2018. Results: From 2009 to 2018, Montreal suicide rates increased but this was not significantly different from the previous 12 years and the rate for other Quebec police remained significantly higher than Montreal (p < .006). The 22-year Montreal postprogram rate was significantly lower than the preprogram rate (p < .002), and the 22-year rate for other police during the same years was not significantly different from earlier. Limitations: Uncontrolled factors may have influenced the rates, including the 11% increase in women in the Montreal police. The observed mean aging of the Montreal police personnel would have been expected to bias toward finding increases in suicides. However, the maintenance of decreases in suicide rates was observed. Conclusion: The decrease in suicides observed 12 years after the program was sustained for another 10 years, and appears related to the program. Rates for comparable police remained higher. A continuing comprehensive suicide prevention program tailored to the context may reduce suicides for extended time periods.

Hirot, F., Ali, A., Azouvi, P., Naddaf, A., Huas, C., Guillaume, S. & Godart, N. (2022). Five-year mortality after hospitalisation for suicide attempt with a violent method. Journal of Psychosomatic Research, 159. DOI: 10.1016/j.jpsychores.2022.110949
This is a study examining the mortality rate of patients hospitalized for a suicide attempt using violent methods. The authors use a base range of five years after hospital discharge.

Abstract – Objective: This study aimed to estimate the 5-year mortality among people admitted into a transdisciplinary unit providing combined psychiatric and somatic rehabilitation treatment. Methods: In this retrospective study, we analyzed the clinical records of all individuals admitted into the transdisciplinary unit from 01/01/2011 to 12/31/2017 after a suicide attempt using violent means. Vital status was ascertained for these 215 people, a standardized mortality ratio (SMR) was calculated and Log-rank tests were used to identify factors associated with mortality. Results: The crude mortality rate was 5.12% (11 deaths) and the SMR was 15.45 (95% CI = [7.71–27.65]; p < 0.001) 5.40 years after admission into the transdisciplinary unit. Factors associated with mortality were: older age (29.91 years versus 25.30 years, p < 0.001), a longer stay in acute care (p = 0.002) and a shorter stay in the transdisciplinary unit (p < 0.001). Conclusion: Long-term mortality among people who have attempted suicide using violent means is 15 times higher than in the corresponding general young adult population. This study supports the hypothesis that the severity of a suicide attempt is associated with subsequent excess mortality. Therefore, there is a need to consolidate outpatient facilities that provide appropriate support for this specific population after discharge. These programmes need to ensure the continuity of coordinated psychiatric and somatic care and psychosocial rehabilitation in order to prevent the risk of suicide.

🇨🇦 Furqan, Z., Cooper, R., Lustig, A., Sinyor, M., Nakhost, A., Kurdyak, P., Rudoler, D., Naeem, F., Stergiopoulos, V. & Zaheer, J. (2022). “I was close to helping him but couldn’t quite get there”: Psychiatrists’ experiences of a patient’s death by suicide. The Canadian Journal of Psychiatry. DOI: 10.1177/070674372211253
A survey of 18 Canadian psychiatrists and their experiences with the suicides of patients in their care.

Abstract – Objectives: A patient’s death by suicide is a common experience for psychiatrists, ranging from 33% to 80%, however, research about the impact of patient suicide on psychiatrists is limited to a few survey studies. This study had three main objectives: (1) understanding the emotional and behavioural impact of a patient’s suicide on psychiatrists, (2) exploring if and how the experience of a patient’s suicide results in changes in psychiatrist practice patterns, and (3) understanding the tangible steps that psychiatrists and institutions take to manage the emotional and behavioural impact of patient suicide on psychiatrists. Methods: Eighteen psychiatrists were recruited using snowball sampling and interviewed to collect demographic data, followed by an in-depth exploration of their experiences of patient suicide. Interviews were then transcribed verbatim and analysed using constructivist grounded theory. Results: Study participants described strong emotional reactions in response to patient suicide. Emotional reactions were mediated by a physician, patient, relationship and institutional factors. While psychiatrists did not change the acuity or setting of their practice in response to patient suicide, they made several changes in their practice, including increased caution regarding discharges and passes from inpatient units, more thorough documentation and continuing education about suicide. Conclusions: Patient suicide has a profound impact on psychiatrists and based on the findings of this study, we propose steps that psychiatrists and institutions can take to manage the emotional, psychological and behavioural burden of this event.

Nicholas, A., Krysinska, K. & King, K. (2022). A rapid review to determine the suicide risk and risk factors of men who are survivors of sexual assault. Psychiatry Research, 317. DOI: 10.1016/j.psychres.2022.114847
A review of the relationship between men who are survivors of sexual assault and their risk of suicide.

Abstract – This rapid review assessed the suicide risk and risk factors of men who are survivors of sexual assault. We searched three academic databases (Cochrane, Medline and PsycINFO) for peer-reviewed articles in English published between 2010 and 2022. We rated the quality of the evidence based on the National Health and Medical Research Council Levels of Evidence. One systematic review and 16 papers featuring primary studies were included relating to suicide rates and risk. Findings suggest men who have been sexually assaulted (as a child or adult) are at increased risk of suicidal thoughts, attempts and behaviours compared with men who have not been sexually assaulted. Factors such as frequency of abuse and other concurrent forms of childhood abuse may further increase the risk of suicidal thoughts and behaviours. This evidence base was rated as good. The strength of this evidence supports a need for targeted suicide prevention in this high risk group.

🇨🇦 Gorton, H., Berry, H., L O’Reilly, C., Gardner, D. & Murphy, A. (2022). Experience and attitudes of pharmacy teams towards suicide prevention: A cross-sectional survey. Research in Social and Administrative Pharmacy. DOI: 10.1016/j.sapharm.2022.09.011
Community pharmacists were surveyed to gauge their experience of suicide and their attitudes toward suicide prevention. The 14-item Attitudes to Suicide Prevention (ASP) was used.

Abstract – Background: Community pharmacists are increasingly recognized as integral members in suicide prevention programs, as part of a multidisciplinary and multifaceted approach. However, further research is required to understand then optimize the whole pharmacy teams’ role across sectors. Objective: To explore pharmacy teams’ experience of, and attitudes towards, suicide prevention in England. Methods: A cross-sectional survey was purposively distributed to pharmacy staff in England before accessing an optional suicide awareness raising video, hosted by Centre for Pharmacy Postgraduate Education (CPPE), in September 2019–March 2021. Questions included demographics and experience of, attitudes towards, and preparedness for, suicide prevention. The 14-item Attitudes to Suicide Prevention (ASP) scale was used (possible range 14–70 with lower scores representing positive attitudes). Descriptive and comparative statistics were reported. Free-text comments were invited to explore respondents’ experience of suicide prevention and reflexive thematic analysis used. Results: Of 403 respondents, 82% were female; most were pharmacists (59%) or pharmacy technicians (21%), with the remainder having other roles. Eighty-five percent worked in community pharmacy. Eleven percent had prior suicide prevention training, and 71% reported interacting with at least one patient about suicide. Most often, suicidality was disclosed by the patient (40%), with 6% of pharmacy staff having directly asked a patient about suicidal behavior or plans. The aggregated ASP score was 31.51 (SD 6.23), and role did not affect experience or attitude. Pharmacy teams’ experiences of suicide prevention can be summarized by three major themes i) Exposure to suicide; ii) Responsibility for action; and iii) Access to means of suicide. Conclusions: Pharmacy teams felt responsibility in caring for those at risk of suicide and had experience of this. Further training should include understanding of medicines means restriction and involve all roles and sectors of pharmacy. Pharmacy teams should be integrated into the ‘circle of care’ to access referral pathways.

Ponder, W., Beauchamp, A., Schuman, D., Carbajal, J., Jetelina, K. (2022). Differences in suicidality in non-treatment-seeking and treatment-seeking law enforcement officers: A cross-sectional study. Journal of Occupational and Environmental Medicine, 64(9), 797-801. DOI: 10.1097/JOM.0000000000002618
This study compared the experiences of suicidal behaviours between law enforcement officers who sought treatment for occupational stress and those who did not seek treatment.

Abstract – Objective: Law enforcement officers (LEOs) are exposed to high levels of occupational trauma and face added stress from heightened public scrutiny and COVID-19, which may result in suicide. It is crucial to understand differences between LEOs who seek treatment and those who do not. Method: We compared LEOs from the same greater metropolitan area who sought treatment with those who did not. Participants completed validated measures assessing posttraumatic stress disorder, generalized anxiety, depression, and suicidality. Results: The treatment-seeking sample scores were higher on all standardized assessments. Bivariate logistic regression results indicated that the non–treatment-seeking sample’s odds of experiencing suicidality were 1.76 times the odds for the treatment seeking sample. Conclusions: This suggests that many LEOs experiencing suicidality may not be seeking treatment and highlights the role that posttraumatic stress disorder may play in determining whether LEOs seek treatment or not.

🇨🇦 Hawley, L., Niederkrotenthaler, T., Zaheer, R., Schaffer, A., Redelmeier, D., Levitt, A., Sareen, J., Pirkis, J. & Sinyor, M. (2022). Is the narrative the message? The relationship between suicide-related narratives and subsequent suicides. Australian & New Zealand Journal of Psychiatry. DOI: 10.1177/00048674221117072
The effects of media portrayals of suicide are examined. The authors aim to discern if there is a relationship between the way the narrative is presented and occurrences of suicide.

Abstract – Objectives: When journalists report on the details of a suicide, the way that they contextualize the meaning of the event (i.e. the ‘narrative’) can have significant consequences for readers. The ‘Werther’ and ‘Papageno’ narrative effects refer to increases and decreases in suicides across populations following media reports on suicidal acts or mastery of crises, respectively. The goal of this study was to investigate the impact of these different narrative constructs on subsequent suicides. Methods: This study examined the change in suicide counts over time in Toronto, Canada. It used latent difference score analysis, examining suicide-related print media reports in the Toronto media market (2011–2014). Articles (N = 6367) were coded as having a potentially harmful narrative if they described suicide in a celebrity or described a suicide death in a non-celebrity and included the suicide method. Articles were coded as having potentially protective narratives if they included at least one element of protective content (e.g. alternatives to suicide) without including any information about suicidal behaviour (i.e. suicide attempts or death). Results: Latent difference score longitudinal multigroup analyses identified a dose–response relationship in which the trajectory of suicides following harmful ‘Werther’ narrative reports increased over time, while protective ‘Papageno’ narrative reports declined. The latent difference score model demonstrated significant goodness of fit and parameter estimates, with each group demonstrating different trajectories of change in reported suicides over time: (χ2[6], N = 6367) = 13.16; χ2/df = 2.19; Akaike information criterion = 97.16, comparative fit index = 0.96, root mean square error of approximation = 0.03. Conclusion: Our findings support the notion that the ‘narrative’ matters when reporting on suicide. Specifically, ‘Werther’ narratives of suicides in celebrities and suicides in non-celebrities where the methods were described were associated with more subsequent suicides while ‘Papageno’ narratives of survival and crisis mastery without depictions of suicidal behaviours were associated with fewer subsequent suicides. These results may inform efforts to prevent imitation suicides.

Shiue, K., Naumann, R., Proescholdbell, S., Cox, M., Aurelius, M., Austin, A. (2022). Differences in overdose deaths by intent: Unintentional & suicide drug poisonings in North Carolina, 2015–2019. Preventative Medicine. DOI: 10.1016/j.ypmed.2022.107217
The ambiguity surrounding unintentional drug poisoning deaths and suicides is explored. Data of North Carolina death certificates from 2015-2019 are used.

Abstract – Comprehensive fatal overdose prevention requires an understanding of the fundamental causes and context surrounding drug overdose. Using a social determinants of health (SDOH) framework, this descriptive study examined unintentional and self-inflicted (i.e., suicide) overdose deaths in North Carolina (NC), focusing on specific drug involvement and contextual factors. Unintentional and suicide overdose deaths were identified using 2015–2019 NC death certificate data. Specific drug involvement was assessed by searching literal text fields for drug mentions. County-level contextual factors were obtained from NC Institute of Medicine and County Health Rankings, encompassing five SDOH domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment). Descriptive statistics were calculated by intent for drug involvement and a variety of contextual factors. During 2015–2019, 9% of NC drug overdose deaths were self-inflicted and 89% were unintentional (2% other/undetermined). Unintentional overdoses largely involved illicit drugs [fentanyl (47%), cocaine (33%), heroin (29%)]. Suicide overdoses frequently involved prescription opioids [oxycodone (18%), hydrocodone (10%)] and antidepressants (32%). Overall, overdose deaths tended to occur in under-resourced counties across all SDOH domains, though unintentional overdoses occurred more often among residents of under-resourced counties than suicide overdoses, with differences most pronounced for economic stability-related factors. There are notable distinctions between unintentional and suicide overdose deaths in demographics and drug involvement, though the assessment of SDOH demonstrated that overdose mortality is broadly associated with marginalization across all domains. These findings highlight the value of allocating resources to prevention and intervention approaches that target upstream causes of overdose (e.g., housing first, violence prevention programs).

Nabi, Z., Stansfeld, J., Plöderl, M., Wood, L. & Moncrieff, J. (2022). Effects of lithium on suicide and suicidal behaviour: A systematic review and meta-analysis of randomized trials. Epidemiology and Psychiatric Sciences. DOI: 10.1017/S204579602200049X
12 studies of the effects of lithium on suicidal behaviours of individuals with mood disorders are reviewed.

Abstract – Aims: Lithium has long been believed to reduce the risk of suicide and suicidal behaviour in people with mood disorders. Previous meta-analyses appeared to support this belief, but excluded relevant data due to the difficulty of conducting meta-analysis of rare events. The current study is an updated systematic review and meta-analysis that includes all eligible data, and evaluates suicide, non-fatal suicidal behaviour (including suicidal ideation) and suicide attempts. Methods: We searched PubMed, PsycINFO and Embase and some trial registers. We included all randomised trials comparing lithium and placebo or treatment as usual in mood disorders published after 2000, to ensure suicide was reliably reported. Trial quality was assessed using the Cochrane Risk of Bias tool. Pooled data were analysed using Fisher’s Exact test. In addition, meta-analysis was conducted using various methods, prioritizing the Exact method. All trials were included in the analysis of suicide initially, regardless of whether they reported on suicide or not. We conducted a sensitivity analysis with trials that specifically reported on suicides and one that included trials published before 2000. Pre-specified subgroup analyses were performed involving suicide prevention trials, trials excluding people already taking lithium, trials involving people with bipolar disorder exclusively and those involving people with mixed affective diagnoses. Non-fatal suicidal behaviour and suicide attempts were analysed using the same methods, but only trials that reported these outcomes were included. PROSPERO registration: CRD42021265809. Results: Twelve eligible studies involving 2578 participants were included. The pooled suicide rate was 0.2% for people randomised to lithium and 0.4% with placebo or treatment as usual, which was not a statistically significant difference; odds ratio (OR) = 0.41 (95% confidence interval 0.03–2.49), p = 0.45. Meta-analysis using the Exact method produced an OR of 0.42 (95% confidence interval 0.01–4.5). The result was not substantially different when restricted to 11 trials that explicitly reported suicides and remained statistically non-significant when including 15 trials published before 2000 (mostly in the 1970s). There were no significant differences in any subgroup analysis. There was no difference in rates of all non-fatal suicidal behaviour in seven trials that reported this outcome, or in five trials that reported suicide attempts specifically. Meta-analyses using other methods also revealed no statistically significant differences. Conclusions: Evidence from randomised trials is inconclusive and does not support the idea that lithium prevents suicide or suicidal behaviours.

🇨🇦 Giesbrecht, N., Farkouh, E., Pavalaghanthan, H & Orpana, H. (2022). Prevention of alcohol-related suicide: A rapid review. Drugs: Education, Prevention & Policy. DOI: 10.1080/09687637.2022.2114877
69 articles looking at alcohol-related suicide prevention interventions were culled from 1990- 2020 and were examined for evidence of efficacy.

Abstract – Suicide remains a leading cause of death worldwide, with an estimated 700,000 suicide deaths per year. The World Health Organization identifies reducing alcohol use as one component of comprehensive approaches to suicide prevention. This paper conducted a rapid review of the evidence on alcohol-related suicide prevention interventions. PubMed, Embase and Web of Science were searched for articles related to alcohol, suicide, prevention, and policies, published between 1990 and 2020. 5293 articles were identified; after deduplication, 2567 studies were screened at the title and abstract level. 402 articles underwent full-text review. 69 articles were ultimately included and underwent data extraction. Interventions were categorized as policy interventions, community-based interventions, and clinical interventions. While there is evidence that policy interventions targeting alcohol may be associated with lower suicide rates, more evidence using stronger study designs is needed. The evidence for community interventions was mixed and supported the need for further research on these types of interventions. Pharmaceutical and therapy-based clinical interventions also showed some promise, with more research needed. Overall, despite evidence of alcohol’s role in suicide attempts and deaths, few interventions have been developed with the purpose of addressing alcohol-related suicide. More research is needed to identify effective interventions to prevent alcohol-related suicide.

de Lange, J., Baams, L., Bos, H., Bosker, R., Dumon, E., Portzky, G., Robinson, J. & van Bergen, D. (2022). Moderating role of coping in the association between minority stress and suicidal ideation and suicide attempts among sexual and gender minority young adults. Suicide and Life-Threatening Behavior. DOI: 10.1111/sltb.12913
The rates of suicidal behaviours are higher among sexual and gender minority (SGM) young adults than among their heterosexual, cisgender young adult counterparts. This paper explores the role minority stress plays in these outcomes and how coping styles may moderate them.

Abstract – Objective: This study examined associations of minority stressors (i.e., victimization, internalized homonegativity, and stigma consciousness), and coping styles (i.e., active, avoidant, and passive) with suicidal ideation and suicide attempts (suicidality) among sexual and gender minority (SGM) young adults, and whether coping style moderated these associations. Methods: Logistic regression analyses examined these associations among 1432 SGM young adults (ages 18–29). Results: Minority stressors and passive coping were associated with a higher likelihood of suicidality. Avoidant coping was associated with a lower likelihood of lifetime suicidal ideation and attempts among sexual minority participants, and active coping with a lower likelihood of past-year suicidal ideation among sexual minority participants. Moderation analyses among sexual minority participants showed that when avoidant coping was high, associations between low victimization (compared with no victimization) and lifetime suicide attempts, and stigma consciousness and lifetime suicide attempts became non-significant, and the association between internalized homonegativity and lifetime suicide at tempts became significant. Among gender minority participants, when passive coping was high the association between low victimization and lifetime suicidal ideation became significant. Conclusion: This study underlines the importance of minority stress and coping for suicidality among SGM young adults and the need for more research regarding the role of coping.

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