Research Roundup – September 2020
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month:
Picardo, J., et al. (2020). Suicide and self-harm content on Instagram: A systematic scoping review. PLOS One, DOI: https://doi.org/10.1371/journal.pone.0238603
Social media platforms are increasingly used as sites for expressions of suicidal and self-harming behaviours. This review looks at ten studies between 2010-2019 examining such expressions via Instagram posts.
Abstract – Given concerns about suicide or self-harm content on Instagram, we conducted a systematic scoping review of peer-reviewed English language primary studies published between 2010–2019. Only ten studies had been published. Looking into purposive samples of Instagram posts tagged with self-harm related hashtags, studies report finding self-harm or suicide content in between 9–66% of their studied posts. Studies assessing Instagram’s efforts to tackle such content found they had not been very effective. Despite heterogeneity in study aims, use of terminology, samples, methods of analysis, and study outcomes, we aggregated and distinguished ‘content studies’ and ‘user studies.’ Most studies showed concern for self-harm risk, but only one examined the relationship between self-harm posts and actual self-harm behaviours offline. It found such content had negative emotional effects on some users and reported preliminary evidence of potential harmful effects in relation to self-harm related behaviours offline, although causal effects cannot be claimed. At the same time, some benefits for those who engage with self-harm content online have been suggested. More research directly interviewing Instagram users to understand this phenomenon from their perspective is required. Finally, some ethical issues are discussed.
Hanson, L., et al. (2020). Work related sexual harassment and risk of suicide and suicide attempts: prospective cohort study. BMJ. DOI: http//dx.doi.org/10.1136/bmj.m2984
This study looks at the association between workplace sexual harassment and suicidal behaviours.
Abstract – Objective: To analyze the relation between exposure to workplace sexual harassment and suicide, as well as suicide attempts. Design: Prospective cohort study. Setting: Sweden. Participants: 86451 men and women of working age in paid work across different occupations responded to a self-report questionnaire including exposure to work related sexual harassment between 1995 and 2013. The analytical sample included 85205 people with valid data on sexual harassment, follow-up time, and age. Main outcome measures: Suicide and suicide attempts ascertained from administrative registers (mean follow-up time 13 years). Results: Among the people included in the respective analyses of suicide and suicide attempts, 125 (0.1%) died from suicide and 816 (1%) had a suicide attempt during follow-up (rate 0.1 and 0.8 cases per 1000 person years). Overall, 11 of 4095 participants exposed to workplace sexual harassment and 114 of 81110 unexposed participants committed suicide, and 61/4043 exposed and 755/80513 unexposed participants had a record of suicide attempt. In Cox regression analyses adjusted for a range of sociodemographic characteristics, workplace sexual harassment was associated with an excess risk of both suicide (hazard ratio 2.82, 95% confidence interval 1.49 to 5.34) and suicide attempts (1.59, 1.21 to 2.08), and risk estimates remained significantly increased after adjustment for baseline health and certain work characteristics. No obvious differences between men and women were found. Conclusions: The results support the hypothesis that workplace sexual harassment is prospectively associated with suicidal behaviour. This suggests that suicide prevention considering the social work environment may be useful. More research is, however, needed to determine causality, risk factors for workplace sexual harassment, and explanations for an association between work related sexual harassment and suicidal behaviour.
🇨🇦 Baril, A. (2020). Suicidism: A new theoretical framework to conceptualize suicide from an anti-oppressive perspective. Disability Studies Quarterly, 40(3).
A lengthy Canadian piece positing the view that suicide needs to be studied from wider and broader perspectives than the traditional medical-model most commonly used.
Abstract – Anchored in queer and crip perspectives, this essay proposes the neologism “suicidism” as a new theoretical framework to conceptualize the oppressive system in which suicidal people experience forms of injustice and violence. The thesis proposed here is that suicidal people suffer both individually and collectively from suicidist violence, an oppression that remains unproblematized in all current interpretations of suicide, including those taken up by anti-oppressive scholars and activists. I pursue three interrelated objectives: 1) interrogate dominant ideas and perspectives on suicidality; 2) make visible and denounce the power relations between suicidal and non-suicidal people; 3) enrich intersectional analyses by naming and problematizing an oppression that has been neglected. In sum, this essay proposes to analyze suicidality by asking the following epistemological questions: What and who is missing from current conceptualizations of suicide? What can we learn from these absences? How might new understandings of suicide, from queer and crip perspectives, help anti-oppressive scholars and activists avoid reproducing forms of oppression toward suicidal people? This essay is divided into two parts. The first part reviews some of the predominant models of suicide to illustrate how they all arrive at the same conclusion—that suicide is never an option—and how this results in a silencing of suicidal subjects. In so doing, I also demonstrate how suicidism is intertwined in forms of ableism/sanism. I conclude this first part by mobilizing the notion of epistemic injustice to theorize both the testimonial and hermeneutical injustices experienced by suicidal subjects. In the second part, I explore additional interpretations of suicide that contrast with the dominant “negative” conceptualizations that seek to prevent it in all circumstances. I demonstrate how even “positive” perspectives of suicidality (e.g. the libertarian position) are founded in forms of ableism/sanism, and that even though they may critique the marginalization of suicidal subjects, they don’t conceptualize their oppression as systemic, nor address it from an anti-oppressive perspective. Critiquing the “positive” conceptualizations of suicide allows me to delineate an alternative conceptualization of suicide rooted in queer and crip perspectives. Mobilizing a queer perspective to study suicide doesn’t mean offering only analyses that take queer theories as a starting point or queer communities as the objects of the study. The intention is rather to queer suicide in a more holistic sense, that is, by applying queering and cripping methods, theories, epistemologies, and prevention strategies to the topic of suicidality. Based on a harm-reduction and a non-coercive suicide approach, I suggest that assisted suicide should be a possibility for suicidal people, a position that relies on an ethics of living and a responsibility toward suicidal people.
Wasserman, D., et al. (2020). Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic. World Psychiatry, 19, 294-306.
A perspective on the pandemic from one of the leading suicidologists in Europe, this paper looks at the utility of universal, selected, and indicated (USI) suicide prevention strategies to mitigate the mental health impacts of the COVID-19 Pandemic.
Abstract – Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates decrease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID-19 pandemic affects risk and protective factors for suicide at each level of the socio-ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post-traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio-economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID-19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow-up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision-makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which contexts.
Parrott, S., et al. (2020). Social media and suicide: A validation of terms to help identify suicide-related social media posts. Journal of Evidence-Based Social Work, 17(5), 624-634. https://doi.org/10.1080/26408066.2020.1788478
A lengthy collection of terms (clinical and colloquial, the obscure and the familiar) used to communicate and describe suicide is culled from social media posts. There is an impressive breadth and variety of these expressions.
Abstract – Background: Communication plays an important role in the prevention of suicide, a leading cause of death in the United States. Prior research suggests people who die by suicide often communicate their intent to more than one member of their social network. The ubiquity of social media in modern society means an individual’s social network may be larger than ever before, which has contributed to a proliferation of colloquial terms and phrases to describe suicide. Aims: The present study collected and validated suicide-related terms from the U.S. English language in 2018–2019. By validating clinical and lay terms with people on the front lines of suicide prevention, the study provides a necessary foundation for lexical analyses of suicide communication on social media. Method: 98 terms related to suicide were collected from online, academic, and other sources. Mental health professionals and members of the electronic mailing list of the American Association of Suicidology were asked to validate terms. Results: The survey validated common terms used to communicate about suicide. Limitations: The lexicon did not capture international phrases. It also did not document less direct language, such as expressions of emotion.
Standley, C.J. (2020). Expanding our paradigms: Intersectional and socioecological approaches to suicide prevention. Death Studies, https://doi.org/10.1080/07481187.2020.1725934
Increasingly, the traditional approaches to the study of suicide are showing their limitations to truly capture the complexity of diverse populations. This paper makes proposals to remedy these deficits.
Abstract: Despite increasing research on suicide, we continue to see rising rates, particularly among youth. In answering recent calls for critical suicidology and transdisciplinary approaches to research, I discuss expanding beyond the paradigmatic confines of suicidology by proposing two related approaches to improve our science: intersectionality theory and socioecological theory. Following a discussion of social identity and its relation to suicide risk, I review the literature on these topics and highlight importance of paying attention to the unique experiences of youth through the study of intersectionality and using socioecological models in our research moving forward.
🇨🇦 Gentil, L., et al. (2020). Determinants of suicidal ideation and suicide attempt among former and currently homeless individuals. Social Psychiatry and Psychiatric Epidemiology. https://doi.org/10.1007/s00127-020-01952-3
A Canadian study of two urban homeless (current and former) populations in Quebec and the incidence of suicidal ideation and attempts during a 12- month period.
Abstract – Purposes: This study identified determinants associated with suicidal ideation, suicide attempt and no suicidal behavior in a 12-month period among 455 former or currently homeless individuals in Quebec (Canada). Methods: Study recruitment took place in 27 organizations located in two major Quebec urban areas, where services for homelessness are offered. Independent variables including clinical, socio-demographic, and service use/outcome variables were measured with eight standardized instruments. Significant associations between these variables and suicidal ideation or attempt in bivariate analyses were produced to build a multinomial logistic regression model using a block approach. Results: Of 455 participants, 72 (15.8%) reported suicidal ideation and 30 (6.6%) suicide attempt, while 353 (77.6%) had not experienced suicidal behavior. Suicide ideation was particularly high among those with generalized anxiety disorder and substance use disorders, and suicide attempt even higher. Participants with higher functional disability and hospitalizations had a higher incidence of suicide attempt, whereas participants with schizophrenia spectrum and other psychotic disorders, those placed in foster care during childhood and with higher stigma scores experienced more suicidal ideation. Conclusions: Suicidal ideation and suicide attempt among currently or recently homeless individuals were both strongly associated with clinical variables. Based on the study results, specific interventions may be promoted to improve screening of homeless individuals with suicidal behavior and prevent hospitalization such as training programs and brief care management interventions, addiction liaison nurses, improved access to primary or specialized ambulatory services, and further development of case management and outreach programs for homeless individuals, especially those with functional disabilities.
Marie, L. et al., (2020). Understanding the transition from suicidal desire to planning and preparation: Correlates of suicide risk within a psychiatric inpatient sample of ideators and attempters. Journal of Affective Disorders, 274, 159-166. doi.org/10.1016/j.jad.2020.05.037
This study looks at the crucial area of suicidal behaviours where thoughts can progress to suicidal planning and preparation.
Abstract – Background: There is a clear need to better understand the trajectory from suicidal ideation to enactment of lethal suicidal behavior. Identification of factors that promote desire and the transition to intent and behavior is critical for the advancement of theory, risk formulation, and prevention. Method: In this cross sectional study, correlates of suicide risk were examined at theoretically distinct points along the trajectory from suicidal thinking to behavior (i.e., desire, plans and preparations, suicide attempt) in a manner consistent with the Three-Step Theory and an ideation-to-action framework. The sample included 197 adult inpatients (60% male, 40% white) hospitalized due to ideation or a recent suicide attempt. Results: Psychological pain and fearlessness about death were associated with desire and plans and preparations for suicide. There were no significant differences in suicide risk correlates between ideators and attempters. Limitations: The primary limitations of the current study relate to the cross-sectional design and the nature of the sample, which do not allow for inference of causal relations, or generalizability to outpatient and community samples or to individuals who die by suicide. Conclusions: Psychological pain and fearlessness about death may function as transitional factors that are associated with the transition from desire to suicidal intent in psychiatric inpatients. Findings have important implications for clinical practice. Treatment interventions should reduce psychological pain, increase safety, and reduce access to means.
🇨🇦 Salway, T., et al. (2020). Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: Detection of a second peak in middle adulthood. Social Psychiatry and Epidemiology. DOI: https://doi.org/10.1007/s00127-020-01946-1
Most suicide prevention interventions along the sexual minority landscape are adolescent-focused. This is a Canadian study determining the need for tailored suicide prevention for sexual minority adults.
Abstract – Purpose: Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985–2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities. Methods: Age and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed metaanalyzed data were used to infer period effects among sexual minorities of all genders. Results: We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18–20 years of age for both genders) and one peak nearing mid-life (30–35 years of age for men; 35–40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity. Conclusion: In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course.
Winsor, D.L., et al. (2020). Depression, suicide, and the gifted student: A primer for the school psychologist. Psychology in the Schools, 57, 1627-1639. doi.org/10.1002/pits.22416
A study of the “gifted” student in the context of the Generation Z cohort (born between 1997 and the present) and their relationship with depression and suicide. Intervention strategies for school psychologists are offered.
Abstract – Growing up gifted often means growing up “different.” As schools struggle to provide appropriately designed interventions for student mental health issues, the role of the school psychologist is becoming increasingly important. In the present article, the role of the school psychologist is discussed, particularly as related to helping gifted students who may be manifesting symptoms of depression, suicidal ideation, and potentially suicidal behavior. Further, a holistic intervention approach is advocated and that accounts for four growth factors—intrapersonal, interpersonal, environmental/contextual, and developmental. Importantly, the specific strategies discussed are designed to help the school psychologist in their many capacities of helping gifted students thrive. Increasingly, however, it must also be recognized that the role of the school psychologist has expanded in recent years, and thus many of the intervention strategies offered may require a team of professionals to effectively implement. Regardless, the strategies discussed are designed to help gifted students thrive in the school setting.
Kourgiantakis, T., et al. (2020). Social work education and training in mental health, addictions, and suicide: A scoping review. Journal of Social Work Education, doi.org/10.1080/10437797.2020.1773363
A review of scholarly literature examining the field of social work education in mental health, addictions, and suicide. The authors collected 23 articles centred on addiction, 17 on suicide, 7 on mental health, and 4 having overlap into more than one area. Best practices in social work education pertaining to these areas are discussed.
Abstract – Social workers have an important role in the field of mental health, and social work programs have a responsibility to prepare students for practice in the field. This scoping review mapped and synthesized the literature on mental health, addictions, and suicide in social work education and training. We found 51 articles that examined social work education in addictions (n=23), suicide (n=17), and mental health (n=7), and some articles (n=4) focused on more than one area. Most articles were empirical studies that used quantitative methods, and only one article did not examine social work education in the United States. The studies showed variability in teaching methods, format of training programs, extent to which theory and practice were linked, and the integration of culture and diversity in the programs. The articles contained recommendations to increase teaching students about mental health, addictions, and suicide in all social work programs. Studies also recommended training for faculty and field instructors, using simulation-based learning methods, including competencies in training programs that target knowledge, skills, values, and beliefs; identifying a theoretical framework; integrating culture and diversity; and evaluating training programs. The article discusses implications for best practices in social work education in mental health, addictions, and suicide.