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

Allen, J., Wexler, L. & Rasmus, S. (2021). Protective factors as a unifying framework for strength-based intervention and culturally responsive American Indian and Alaska Native suicide prevention. Prevention Science. DOI: 10.1007/s11121-021-01265-0
A protective factor framework for suicide prevention is proposed for Indigenous populations in the United States.

Abstract – The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by contemporary prevention science. A promising development in AIAN suicide prevention highlights the role of protective factors. A protective factor framework adopts a social ecological perspective and community-level intervention paradigm. Emphasis on protection highlights strength-based AIAN cultural strategies in prevention of youth suicide. Attention to multiple intersecting levels incorporates strategies promoting community as well as individual resilience processes, seeking to influence larger contexts as well as individuals within them. This approach expands the scope of suicide prevention strategies beyond the individual level and tertiary prevention strategies. Interventions that focus on mechanisms of protection offer a rigorous, replicable, and complementary prevention science alternative to risk reduction approaches. This selected review critically examines recent AIAN protective factor suicide prevention science. One aim is to clarify key concepts including protection, resilience, and cultural continuity. A broader aim is to describe the evolution of this promising new framework for conducting primary research about AIAN suicide, and for designing and testing more effective intervention. Recommendations emphasize focus on mechanisms, multilevel interactions, more precise use of theory and terms, implications for new intervention development, alertness to unanticipated impacts, and culture as fundamental in a protective factors framework for AIAN suicide prevention. A protective factor framework holds significant potential for advancing AIAN suicide prevention and for work with other culturally distinct suicide disparity groups, with broad implications for other areas of prevention science.

Kothari, R., Key, R., Lawrenson, J., Squire, T., Farnham, F., & Underwood, A. (2021). Understanding the risk of suicide among perpetrators who view child sexual abuse material (CSAM). Journal of Forensic and Legal Medicine, 81, 102188. DOI: 10.1016/j.jflm.2021.102188
Arrests of perpetrators of child sexual abuse (CSA) have increased in recent years. This has been accompanied by an increase in suicides among this group. “This qualitative study investigates the experiences of CSAM perpetrators from the perspectives of law enforcement officers (n = 16), CSAM perpetrators themselves (n = 5), and help-line operators who have provided support to CSAM perpetrators”.

Abstract – Attempts to address the threat of harm posed by perpetrators of child sexual abuse (CSA) have rightly increased in recent years, with well-known efforts such as operation NOTARISE resulting in 750 arrests; however, the cost of such operations is also high. Operation NOTARISE resulted in 24 suicides; the estimated economic and social cost of which has been estimated to be £34.8 million.[1] Perpetrators who view child sexual abuse materials (CSAM) are not only at higher risk of suicide than the general population, individuals diagnosed with a mental health disorder, and perpetrators of other violent and sexual crimes,[2-5] but they also appear to be at higher risk of suicide than perpetrators of CSA who engage directly in sexual acts with a child .[6-8] An in-depth understanding of the experiences of CSAM offenders is missing in the literature, but is required to understand how to mitigate the risk of suicide amongst this high risk group. This qualitative study investigates the experiences of CSAM perpetrators from the perspectives of law enforcement officers (n = 16), CSAM perpetrators themselves (n = 5), and help-line operators who have provided support to CSAM perpetrators through the Lucy Faithfull Foundation “Stop it now!” helpline (n = 6). Analysis was conducted separately for each dataset and in accordance with guidelines set out by Braun and Clark [9]. The focus of this paper is the six over-arching themes that were common across all datasets: (i) offender demographics; (ii) psychological impact of arrest; (iii) coping with the investigation; (iv) cognitive distortion; (v) shame and stigma; and (vi) professional support. Findings are discussed in the context of the challenges faced by law enforcement and healthcare professions when providing support to this high risk group, and eight key recommendations are made to reduce the risk of suicide.

Salvatore, T. (2021). Dying by suicide in nursing homes: A preventable end of life outcome for older residents. OMEGA Journal of Death and Dying, 1-18. DOI: 10.1177/00302228211038798
Older adult residents who die by suicide in nursing homes have not been researched extensively. This present study looks at this population.

Abstract – Suicide research and suicide prevention have given comparatively little attention to the older adult residents of nursing homes. This population is characterized by advanced age, significant infirmity, limited autonomy and social connections, and other factors associated with high suicide risk such as self-neglect. However, little is known of the actual incidence and prevalence of suicide in older adults in such residential care settings, partly because of how such deaths are reported. Suicide risk screenings are nominal, facility staff lack training to identify signs of suicidality, and suicide prevention programs are not common in the nursing home industry. These deficits can be remedied by increasing awareness among family members, facility caregivers, contracted providers, community aging services, accrediting and regulatory agencies, and residents.

Andriessen, K., Krysinka, K., Rickwood, & D., Pirkis, J. (2021). “Finding a safe space”: A qualitative study of what makes help helpful for adolescents bereaved by suicide. Death Studies. Published online 27 August 2021. DOI: 10.1080/07481187.2021.1970049
There is an acknowledged gap in research that examines what is helpful for adolescents bereaved by suicide. This qualitative study of 18 adolescents who have lost someone to suicide addresses this gap.

Abstract – Experiencing a death by suicide is a devastating event in the lives of adolescents; however, little is known about what makes help helpful according to their experiences. Thematic analysis of individual and group interview data (N = 18) yielded four themes: feeling connected with, and understood by a helper, having a sense of control over, and access to the help as needed. Findings indicate that help should be based on supportive and educational approaches with respect to the adolescents’ agency and the family context. Help must be accessible on a long-term basis while catering for flexible usage.

🇨🇦 Corthésy-Blondin, L., Genest, C., Dargis, L., Bardon, C., & Mishara, B. L. (2021). Reducing the impacts of exposure to potentially traumatic events on the mental health of public safety personnel: A rapid systematic scoping review.  Psychological Services. Published online 2 August 2021. DOI: 10.1037/ser0000572.
This is a rapid review of publications from 2013 and 2020 that evaluate psychosocial interventions for work-related traumatic events experienced by public safety personnel. The researchers were seeking interventions that reduced negative consequences of traumatic exposure.

Abstract – Police, firefighters, and emergency medical technicians and paramedics are frequently exposed to potentially traumatic events (PTE) in their work as public safety personnel (PSP). PTE are a risk factor for posttraumatic stress disorder, depression, anxiety, substance abuse, and suicidal ideation. This systematic rapid scoping review summarizes evaluation research on psychosocial interventions to reduce the negative consequences of exposure to work-related PTE on the mental health of PSP. Articles were identified using PubMed and PsycInfo. Publications from January 1, 2013, to December 1, 2020, were retained because the research published before 2013 was covered by other reviews. We identified 601 unique documents; 30 met preliminary eligibility criteria; and 18 were retained. Most studies were limited to police officers and firefighters. Participants exposed to prevention measures reported improvements of symptoms of depression, burnout, anxiety, sleep problems, and well-being. Most articles identified factors that may hinder or facilitate the use of program components. Studies on ways to support PSP recently affected by a PTE are lacking. There are little data on the efficacy of prevention programs in reducing the prevalence of mental disorders associated with PTE. More studies should focus on identifying participant characteristics and intervention components that influence program use, adherence, and efficacy. Realistic evaluations combined with participatory research could help address important knowledge gaps.

King, K. Krysinka, 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 have been separated from intimate relationships may have higher rates of suicidal ideation and behaviours. This is rapid review of studies that looks at this situation and at potential suicide prevention interventions.

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.

🇨🇦 Brenna, C., Links, P., Tran, M., Sinyor, M., Heisel, M., & Hatcher, S. (2021). Innovations in suicide assessment and prevention during pandemics. Public Health Research Practice. DOI: 10.17061/phrp3132111
A systematic review of studies examining the association between “past infectious disease-related public health emergencies (pandemics and epidemics)” and suicide. The researchers then assess the potential impact of the COVID-19 pandemic on suicidal outcomes.

Abstract – Emerging evidence, based on the synthesis of reports from past infectious disease-related public health emergencies, supports an association between previous pandemics and a heightened risk of suicide or suicide-related behaviours and outcomes. Anxiety associated with pandemic media reporting appears to be one critical contributing factor. Social isolation, loneliness, and the disconnect that can result from public health strategies during global pandemics also appear to increase suicide risk in vulnerable individuals. Innovative suicide risk assessment and prevention strategies are needed to recognise and adapt to the negative impacts of pandemics on population mental health.

Jacups, S. & Kozlowski, W. (2021). Safety planning for youth with suicide risk: A clinical audit. Australian Social Work. DOI: 10.1080/0312407X.2021.1950788
This is an Australian clinical audit of emergency department presentations by 13-17 year-olds with suicidal behaviours. It was conducted over two 3-monthly periods and specifically looks at Safety Planning Interventions (SPI) among this population.

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.

Bechel, A., Range, L. & Remley, T. (2021). School counsellors’ exposure to student suicide, suicide assessment self-efficacy, and workplace anxiety: Implications for training, practice, and research. The Professional Counsellor, 11(3), 327-339.
The authors conducted a survey of school counsellors with membership in the American School Counselor Association. The aim was to gauge the prevalence of suicide training among counsellors and feelings of suicide assessment self-efficacy and workplace anxiety between those exposed to student suicide and those who had no exposure.

Abstract – In a national sample of current school counselors with membership in the American School Counselor Association (N = 226), we examined the prevalence of suicide training among school counselors as well as differences in suicide assessment self-efficacy and workplace anxiety between school counselors who were exposed to student suicide and those who were not. The results indicate that 38% of school counselors were not prepared for suicide prevention during graduate training. Although school counselors’ exposure to suicide was not related to their workplace anxiety, those who were exposed to a student suicide attempt had higher suicide assessment self-efficacy scores than those who were not. This study demonstrates the impact of suicide exposure on school counselors and the need for additional suicide assessment training.

Rosebrock, H., Batterham, P., Chen, N., McGillivray, L., Rheinberger, D., Torok, M., & Shand, F. (2021). Nonwillingness to return to Emergency Department and nonattendance of follow-up care arrangements following an initial suicide-related presentation. Crisis. DOI: 10.1027/0227-5910/a000812
This is an Australian study of people who have experienced a suicidal crisis and visited an emergency department and their subsequent willingness to participate in follow-up care.

Abstract – Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients’ nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients’ experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.

🇨🇦 Tan, J. (2021). Suicide prevention: A sociocultural approach to understanding suicide among the Inuit—Issues and prevention strategies. In R. Schiff and H. Moeller (Eds.). Heath and Health Care in Northern Canada, 255-273. University of Toronto Press.
This is a chapter from an anthology of writings on health and healthcare in Northern Canada. Tan looks at suicide among the Inuit through a socio-cultural lens.

Abstract – Old and new forms of colonial programs and policies continue to create health and health care disparities in the North. Written by individuals who live in and study the region, Health and Health Care in Northern Canada utilizes case studies, interviews, photographs, and more, to highlight the lived experiences of northerners and the primary health issues that they face. In order to maintain resilience, improve the positive outcomes of health determinants, and diminish negative stereotypes, we must ensure that northerners – and their cultures, values, strengths, and leadership – are at the centre of the ongoing work to achieve social justice and health equity.

🇨🇦 McIntyre, R., Lui, L., Rosenblat, J., Ho, R., Gill, H., Mansur, R., Teopiz, K., Liao, Y., Lu, C., Subramaniapillai, M., Nasri, F., & Lee, Y. (2021). Suicide reduction in Canada during the COVID-19 pandemic: Lessons informing national prevention strategies for suicide reduction. Journal for the Royal Society of Medicine. DOI: 10.1177/01410768211043186
A team of Canadian researchers examine suicide mortality and the unemployment rate between March 2019-February 2020 and March 2020-February 2021.

Abstract – Objective: The objective of this research was to evaluate the impact of federal, public health and social support programs on national suicide rates in Canada. Design: Cross-sectional study. Setting: Canadian National Database (i.e., Statistics Canada) and Statista. Participants: Population-level data, and economic and consumer market data. Main Outcome Measures: Suicide mortality data, population data and unemployment data were obtained from available statistical databases (e.g. Statistics Canada). We quantified suicide rate by dividing the total number of suicide deaths by the national population expressed as a rate per 100,000 population. Results: Overall suicide mortality rate decreased in Canada from 10.82 deaths per 100,000 in the March 2019 – February 2020 period to 7.34 per 100,000 (i.e. absolute difference of 1300 deaths) in the March 2020 – February 2021 period. The overall Canadian unemployment rate changed from an average monthly rate of 5.7% in 2019 to 9.5% in 2020. Conclusion: Our results indicate that for the first post-pandemic interval evaluated (i.e., March 2020 – February 2021), suicide rates in Canada decreased against a background of extraordinary public health measures intended to mitigate community spread of COVID-19. An externality of public health measures was a significant rise in national unemployment rates in population measures of distress. Our results suggest that government interventions that broadly aim to reduce measures of insecurity (i.e., economic, housing, health), and timely psychiatric services, should be prioritized as part of a national suicide reduction strategy, not only during but after termination of the COVID-19 pandemic.

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