Research Roundup – September 2022
This is a summary of the latest significant Canadian (
) and international suicide research we collected in the past month:
🇨🇦 Cote, L. &Mishara, B. (2022). Effect of helping suicidal people using text messaging: An evaluation of effects and best practices of the Canadian suicide prevention Service’s text helpline. Suicide and Life-Threatening Behavior. DOI: 10.1111/sltb.12908
There is a lack of research on best practices in suicide prevention concerning text messaging to helplines. This is a Canadian study analyzing and evaluating 112 transcripts culled from the Canadian Suicide Prevention Service’s text helpline.
Abstract – Background: Empirical research on best practices in suicide prevention text intervention is scarce. We present analyses of exchanges concerning suicide on the Canadian Suicide Prevention Service (CSPS) text helpline. Objective: To describe the users of the CSPS text service, explore the perceived impact of the service, and identify intervention characteristics associated with a greater likelihood of positive or negative effects of the exchanges. Methods: We analyzed data from 112 transcripts using quantitative content analysis, counselor assessments of the calls, and responses by callers to pre-call questionnaires. Results: Counselors infrequently conducted a complete suicide risk assessment, but almost always thoroughly explored resources and discussed possible solutions to callers’ problems. An operational action plan was rarely developed. Only one technique, reinforcing a strength or a positive action of the caller, was a significant predictor of positive effects of the call. The number of words exchanged during the intervention was positively correlated with the completeness of explorations of resources and solutions and the development of an action plan. Conclusions: High-quality effective interventions can be delivered via text messages. Using reinforcement of strengths and encouraging longer calls is recommended. Intervention effects were comparable to those reported in studies of telephone and chat services.
Ehret, B., Chalker, S., Pozun, T., Martinez-Ceren, C. (2022). A peer approach to suicide prevention and recovery: Study protocol for a feasibility and acceptability trial of Caring Cards for veterans. Contemporary Clinical Trials Communications. DOI: 10.1016/j.conctc.2022.100974
A study protocol proposing a study of a peer-to-peer intervention for U.S. veterans—caring cards. It will be a 2-year open-trial study of veterans with a history of suicide risk creating hope-filled cards for veterans with mental health concerns.
Abstract – Introduction: There is a need to develop, evaluate, and implement interventions that reduce Veteran suicide. Caring Cards (CC) is a novel intervention that integrates aspects of caring contacts and peers (i.e., persons with lived mental health experience). In CC, Veterans meet in a weekly group to create hope-filled cards that are sent to Veterans with mental health concerns. This study will examine feasibility and acceptability of CC with Veterans with a history of and current elevated suicide risk via in-person and virtual modalities and preliminarily evaluate pre/post changes on suicide-specific outcomes. Methods: This 2-year open-trial study will employ a pre/post research design. Recruited Veterans with a history of suicide risk (n = 30) will make up CC groups (card makers) and Veterans currently at high-risk for suicide (n = 50) will be card recipients. Feasibility and acceptability (recruitment, retention, attendance, card receipt rates, and satisfaction questionnaire responses) and pre/post changes on suicide-specific outcomes (i.e., thwarted belonginess, perceived burdensomeness, social connectedness, suicidal ideation, and behavior) will be evaluated. Groups will meet weekly for 90–120 min for three to six months; card recipients will receive one card per month for six months. Discussion: This study builds on preliminary data which indicate Veterans are interested in and find participating in CC highly meaningful. This study is innovative as it will target two new Veteran populations and use both in-person and virtual modalities. If feasible and acceptable, a large-scale efficacy trial will be conducted to further examine CC as a suicide prevention intervention for Veterans.
Benson, R., Brunsdon, C., Rigby, J., Corcoran, P., Ryan, M., Cassidy, E., Dodd, P., Hennebry, D. & Arensman, E. (2022). Real-time suicide surveillance supporting policy and practice. Global Mental Health. DOI: 10.1017/gmh.2022.42
The authors of this editorial stress the importance of real-time suicide surveillance for suicide prevention and suicide prevention policies.
Abstract – Suicide mortality rates are a strong indicator of population mental-health and can be used to determine the efficacy of prevention measures. Monitoring suicide mortality rates in real-time provides an evidence-base to inform targeted interventions in a timely manner and accelerate suicide prevention responses. This paper outlines the importance of real-time suicide surveillance in the context of policy and practice, with a particular focus on public health and humanitarian crises.
Cortero, H., McCullom W. & Kochuba, M. (2022). Increased suicide risk among older white males. Current Trauma Reports. DOI: 10.1007/s40719-022-00233-5
This is a literature review looking at suicide risk factors for older white males, a demographic with elevated suicide rates.
Abstract – Purpose of Review: As one of the leading causes of death worldwide, suicide has become an important public health concern. Several studies have evaluated key demographic factors such as age, gender, and race as increased risk factors for suicide. The goal of this review is to highlight elderly white males as a unique population at risk, as well as help shape future preventive efforts. Recent Findings: Extensive literature review shows that many risk factors contribute to increased suicide rates in older white males. These may include the presence of mental illness, multiple medical conditions, family history, and occupation. In addition, there has been more evidence to suggest that social isolation and access to firearms as increasingly important suicide risk factors to consider, especially among older white males. Summary: Increasing awareness of older white males as an at-risk group and focusing on minimizing social isolation and access to firearms may play significant roles in helping shape future preventative efforts relating to suicide.
Doyle, M., Ainsworth, P., Boul, S. & Lee, D. (2022). Evaluation of a system for real-time surveillance of suicide in England. Crisis. DOI: 10.1027/0227-5910/a000874
This is an evaluation of a real-time suicide surveillance system (RTSS) in South Yorkshire, England. “Outcome data were analyzed for 2019 and 2020 based on recorded suspected suicides, a stakeholder focus group, evaluation of postvention bereavement service outcomes, and lessons learned.”
Abstract – Background: Access to timely data on suicide is crucial to support suicide prevention. A real-time suicide surveillance (RTSS) system enables public health teams and allied agencies to review information following suicides promptly and take action quickly. Aims: The aim of this paper was to report on an evaluation of an RTSS system in South Yorkshire, England. Method: The system was reviewed, and outcome data were analyzed for 2019 and 2020 based on recorded suspected suicides, a stakeholder focus group, evaluation of postvention bereavement service outcomes, and lessons learned. Results: The benefits of RTSS included rapid response to emerging trends, identifying clusters, effective bereavement support, information to inform measures to mitigate risk, and supporting evaluation of interventions. The challenges faced included limited resources, data quality, consistency across places, and linkages with coronial processes. Limitations: This was an evaluation of one RTSS system based on routinely collected data covering one area, South Yorkshire, and hence some data limitations, and direct comparison with other services or against a control group was not possible. Conclusion: The RTSS system has led to better support for suicidal people and a responsive, timely, and effective service for those bereaved by suicide, all of which are likely to lead to enhanced well-being and community resilience.
🇨🇦 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 in media reports and subsequent suicides? Australian and New Zealand Journal of Psychiatry. DOI: 10.1177/00048674221117072
A Canadian paper investigating the positive and negative effects media have on how they report suicide. Toronto-area print media reports of suicide from 2011-2014 are used.
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.
McGill, K., Bhullar, N., Batterham, P., Carrandi, A., Wayland, S. & Maple, M. (2022). Key issues, challenges, and preferred supports for those bereaved by suicide: Insights from postvention experts. Death Studies. DOI: 10.1080/07481187.2022.2112318
Experts in postvention are surveyed to identify the most important issues for those bereaved by suicide in the first 2 years after a suicidal death.
Abstract – For many, suicide bereavement is challenging. Postvention responses are few and evidence to inform them is lacking. Eighteen postvention experts completed an online survey regarding the key issues, challenges, and supports available to people bereaved by suicide. Participants were asked to identify the issues, then rank them in terms of importance at key times during the first 2 years after death, with navigating grief, managing relationships, and dealing with practical challenges identified. Access to information, practical assistance and non-judgmental support were most important early in the bereavement period. These findings provide a foundation for recommendations for postvention interventions.
Mantinieks, D., Schumann, J., Drummer, H., Woodford, N. & Gerostamoulos, D. (2022). Stimulant use in suicides: A systematic review. Forensic Science International. DOI: 10.1016/j.forsciint.2022.111391
Abstract – A systematic review was conducted to gauge the prevalence of stimulant use in suicidal death. 26 studies were analyzed. Suicide remains a global public health concern and the increased supply and use of synthetic stimulants globally may have implications for the burden of suicides attributable to substance use. This systematic review investigated any potential associations of stimulant use detected in post-mortem biological specimens and suicides. We conducted a systematic review and narrative synthesis (CRD42021237966). Medline, EMBASE, TOXLINE, and Scopus databases were searched for terms related to forensic toxicology, post-mortem toxicology, suicide and stimulants. The primary outcome was to estimate the prevalence of stimulant use in suicides. There were 26 studies which contributed to prevalence measures; in studies reporting at the individual compound level, suicides involved cocaine (0.1–23%), caffeine (3.2–22%), 3,4-methylenedioxymethamphetamine (0.1–17%), amphetamine (0.2–9.3%), methamphetamine (3.1–7%), and phentermine (0.9–1%). Overall, stimulant use in suicides was over-represented compared to estimates of stimulant use in the general population and has increased over time. Thirteen case reports used to contextualise suicides involving stimulants found no examples of cocaine or methamphetamine mono-intoxication of suicidal intent. This suggests mechanisms other than acute toxicity involved in stimulant-associated suicide. Future research by in-depth psychological autopsies of suicides involving stimulants, in combination with segmental hair analysis to determine the chronicity of stimulant exposure, may contribute to a better understanding of the burden of suicide attributable to stimulant use.
Van Wyk, J. & Gibson, K. (2022). An analysis of young clients’ communications about their suicidality on at text messaging helpline: “ I’m scared of what I might do to myself”. Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2022.925830
This study aimed to capture youth’s experience of suicidality during a moment of crisis. Text messages to a helpline were analyzed.
Abstract – Background: Youth suicide is a major international concern and prevention is a priority. In most cases suicidal behavior would be preceded by a period of suicidal ideation. Although feeling suicidal is recognized as a risk factor for suicide, there is little research which captures young people’s own experience of suicidality in a moment of crisis. Aims: This study aimed to explore young people’s own accounts of their suicidality in the moment in which they experienced it. Method: This qualitative study examined clients’ experience of suicidality as communicated during a text message helpline counseling interaction. The data consisted of 125 text transcripts of an interaction during which a client was experiencing suicidality. These were obtained from a New Zealand based youth helpline service. The data was analyzed using thematic analysis. Findings: The analysis showed that clients’ experienced suicidality as a normal part of their life; that it was understood as a form of coping and that it was seen as a legitimate way to communicate distress. Clients described rapid fluctuations in the intensity of their suicidality and a feeling of being out of control. Despite this, they also communicated ambivalence about acting on their suicidality, and a recognition of the need to get help. Conclusions: This study offered unique insights into young people’s experience of suicidality and opens up opportunities for prevention. It underlines the importance of identifying chronic suicidality early and providing intervention and support prior to a suicidal crisis. The findings point to the potential that text counseling services might have in providing support to young people who are experiencing suicidality in the moment that they need this.
🇨🇦 Giesbrecht, N., Farkouh, E., Pavalaghanthan, H. & Orpana, H. (2022). Prevention of alcohol-related suicide: A rapid review. Drugs: Education, Prevention and Policy. DOI: 10.1080/09687637.2022.2114877
This is a Canadian review of 69 studies looking at alcohol-related suicide prevention interventions. Articles “articles related to alcohol, suicide, prevention, and policies” were culled from the 1990-2020 time period.
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.