Influence of Spiritual Dimensions on Suicide Risk: The Role of Regional Differences

The field of suicide prevention has been enriched by research on the association between spirituality and suicide. Many authors have suggested focusing on the various dimensions of religiosity in order to better understand the association between religion and suicidal risk, but it is unclear whether the relationship between spirituality and suicidality differs between countries with different cultures, life values, and sociohistorical experiences. To explore this, the aim of this multicenter study was to investigate the possible relationship between suicide and spirituality in Italy and Austria. In the two countries, two different groups of subjects participated: psychiatric patients and university students. The patients were evaluated with the Mini International Neuropsychiatric Interview. In addition, the following measures were used: a sociodemographic questionnaire, the Columbia-Suicide Severity Rating Scale-B, the Symptom-Checklist-90-Standard, and the Multidimensional Inventory for Religious/Spiritual Well-Being. Our results confirmed the multifactorial nature of the relation between suicide risk and the various religious/spiritual dimensions, including religious/spiritual well-being and hope immanent. However, regional differences moderated this relationship in both the clinical and nonclinical samples.

Association of suicidal behavior with exposure to suicide and suicide attempt: A systematic review and multilevel meta-analysis

BACKGROUND

Exposure to suicidal behavior may be associated with increased risk of suicide, suicide attempt, and suicidal ideation and is a significant public health problem. However, evidence to date has not reliably distinguished between exposure to suicide versus suicide attempt, nor whether the risk differs across suicide-related outcomes, which have markedly different public health implications. Our aim therefore was to quantitatively assess the independent risk associated with exposure to suicide and suicide attempt on suicide, suicide attempt, and suicidal ideation outcomes and to identify moderators of this risk using multilevel meta-analysis.

METHODS AND FINDINGS

We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, ASSIA, Sociological Abstracts, IBSS, and Social Services Abstracts from inception to 19 November 2019. Eligible studies included comparative data on prior exposure to suicide, suicide attempt, or suicidal behavior (composite measure-suicide or suicide attempt) and the outcomes of suicide, suicide attempt, and suicidal ideation in relatives, friends, and acquaintances. Dichotomous events or odds ratios (ORs) of suicide, suicide attempt, and suicidal ideation were analyzed using multilevel meta-analyses to accommodate the non-independence of effect sizes. We assessed study quality using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies. Thirty-four independent studies that presented 71 effect sizes (exposure to suicide: k = 42, from 22 independent studies; exposure to suicide attempt: k = 19, from 13 independent studies; exposure to suicidal behavior (composite): k = 10, from 5 independent studies) encompassing 13,923,029 individuals were eligible. Exposure to suicide was associated with increased odds of suicide (11 studies, N = 13,464,582; OR = 3.23, 95% CI = 2.32 to 4.51, P < 0.001) and suicide attempt (10 studies, N = 121,836; OR = 2.91, 95% CI = 2.01 to 4.23, P < 0.001). However, no evidence of an association was observed for suicidal ideation outcomes (2 studies, N = 43,354; OR = 1.85, 95% CI = 0.97 to 3.51, P = 0.06). Exposure to suicide attempt was associated with increased odds of suicide attempt (10 studies, N = 341,793; OR = 3.53, 95% CI = 2.63 to 4.73, P < 0.001), but not suicide death (3 studies, N = 723; OR = 1.64, 95% CI = 0.90 to 2.98, P = 0.11). By contrast, exposure to suicidal behavior (composite) was associated with increased odds of suicide (4 studies, N = 1,479; OR = 3.83, 95% CI = 2.38 to 6.17, P < 0.001) but not suicide attempt (1 study, N = 666; OR = 1.10, 95% CI = 0.69 to 1.76, P = 0.90), a finding that was inconsistent with the separate analyses of exposure to suicide and suicide attempt. Key limitations of this study include fair study quality and the possibility of unmeasured confounders influencing the findings. The review has been prospectively registered with PROSPERO (CRD42018104629).

CONCLUSIONS

The findings of this systematic review and meta-analysis indicate that prior exposure to suicide and prior exposure to suicide attempt in the general population are associated with increased odds of subsequent suicidal behavior, but these exposures do not incur uniform risk across the full range of suicide-related outcomes. Therefore, future studies should refrain from combining these exposures into single composite measures of exposure to suicidal behavior. Finally, future studies should consider designing interventions that target suicide-related outcomes in those exposed to suicide and that include efforts to mitigate the adverse effects of exposure to suicide attempt on subsequent suicide attempt outcomes.

Suicide and Personality Traits: A Multicenter Study of Austrian and Italian Psychiatric Patients and Students

OBJECTIVE

The aim of this multicenter study was to investigate the differences in personality traits, particularly Neuroticism, in three clinical samples and three student samples in Austria and Italy and their impact on suicide.

METHODS

In total, 1,043 people (410 psychiatric inpatients and 633 university students) were tested in three regions of Europe: central Italy, northeast Italy, and eastern Austria. Psychiatric diagnoses were evaluated using the Mini-International Neuropsychiatric Interview, and the following instruments were used: Sociodemographic Questionnaire, Columbia-Suicide Severity Rating Scale-B, Symptom-Checklist-90-Standard, and Big Five Inventory.

RESULTS

The study found that the intensity of Suicidal Ideation was associated with the personality traits of Neuroticism, Anxiety, and Extraversion but also with Depression.

CONCLUSIONS

In conclusion, without the presence of Depression symptoms, neuroticism was a protective factor against Suicidal Ideation, whereas neuroticism when comorbid with Depression symptoms increased suicide risk in psychiatric patients. In all three regions, the clinical samples had higher scores for Neuroticism and for Depression symptoms than the student sample and consequently higher scores for Suicide. Furthermore, we demonstrated an interaction between gender and culture on personality traits, supporting the hypothesis that the distribution of self-reported personality traits is organized geographically.

The Portrayal of Suicidal Behavior in Police Television Series

Fictional suicidal behavior can affect the public as a risk or a protective factor, and it may reflect how suicide is perceived in a society. However, surprisingly little is known of how suicidal behavior is portrayed in television series. The aim of this study was to investigate the characteristics of televised fatal and non-fatal suicidal behavior, preventative interventions, and the portrayal of people bereaved by suicide. All episodes (N = 475) of four Belgian police series were screened against inclusion and exclusion criteria, and 87 episodes with a total of 54 suicides, 13 attempted suicides, 13 suicide threats, and 20 characters bereaved by suicide were included in a quantitative and qualitative analysis. Televised suicidal behavior was primarily motivated by external motives, such as social/relational issues or the death of a significant other, and to a lesser extent, by internal motives, such as mental or physical health related issues. Interventions were likely to prevent suicide. People bereaved by suicide were mostly portrayed as individuals seeking justice. Shame, revenge, and escape were the major qualitative themes associated with suicidal behavior. Two prototypes emerged: a ruthless, "psychopath" type criminal, who kills him/herself before being arrested, and a suicidal individual struggling with devastating life events. The study provided unique insights in how suicidal behavior is televised in Belgian police series. Though some characteristics were portrayed adequately, mental health related issues were overlooked, spectacular suicide methods were overrepresented, and the bereaved characters were mostly unidimensional revengers. Strategies for improving the accuracy of televised suicidal behavior should be studied.

Suicide Postvention Service Models and Guidelines 2014-2019: A Systematic Review

Background: Suicide bereavement can have a lasting and devastating psychosocial impact on the bereaved individuals and communities. Many countries, such as Australia, have included postvention, i.e., concerted suicide bereavement support, in their suicide prevention policies. While little is known of the effectiveness of postvention, this review aimed to investigate what is known of the effects of postvention service delivery models and the components that may contribute to the effectiveness.

Method: Systematic review and quality assessment of peer reviewed literature (Medline, PsycINFO, Embase, EBM Reviews) and gray literature and guidelines published since 2014.

Results: Eight studies and 12 guidelines were included, with little evidence of effectiveness. Still, providing support according to the level of grief, involvement of trained volunteers/peers, and focusing the interventions on the grief, seem promising components of effective postvention.

Conclusions: Adopting a public health approach to postvention can allow to tailor the service delivery to needs of the bereaved individuals and to align postvention with suicide prevention programs.

New adolescent grief scales open new research possibilities: A commentary

In this commentary, we highlight the availability of two newly developed instruments that measure grief in adolescents. We present similarities and differences regarding their content, factor structure, and characteristics of the validated populations. Given the small body of adolescent grief instruments, these two new scales will prove to be useful instruments to enhance our knowledge of grief and effectiveness of grief interventions in this population.

Grief After Euthanasia and Physician-Assisted Suicide

Background: Several countries have regulated euthanasia and physician-assisted suicide (PAS). Research has looked at the experiences of patients, family, and professionals. However, little is known of the effects on bereaved individuals. Aims: We aimed to assess (a) what is known about the grief and mental health of people bereaved by euthanasia or PAS and (b) the quality of the research. Method: Systematic review according to PRISMA guidelines with searches in Cinahl, Embase, PsycINFO, Pubmed, and Scopus. Results: The searches identified 10 articles (eight studies), and the study quality was fair. People bereaved by euthanasia/PAS generally had similar or lower scores on measures of disordered grief, mental health, and posttraumatic stress compared with those who died naturally. Lack of social support and secrecy may compound their grief. Being involved in the decision-making process and having the feeling of honoring the deceased's will may facilitate their grief. Limitations: Studies used self-reports from non-random self-selected participants, were retrospective, and were conducted in only three countries. Conclusion: There is little evidence of increased risk of adverse grief or mental health outcomes in people bereaved by euthanasia/PAS. As more countries legalize assisted dying, high-quality studies of the factors that may hinder or facilitate the grief process are needed.

Ethical Concerns in Suicide Research: Results of an International Researcher Survey

Researchers and research ethics committees share a common goal of conducting ethically sound research. However, little is known of researchers' experiences in obtaining ethics approval for suicide-related studies. This study aimed to investigate what concerns researchers have received on suicide-related ethics applications and how they dealt with it. Thirty-four respondents, recruited through the International Association for Suicide Prevention, filled out an online survey. The study found that researchers have received important concerns regarding potential harm and researchers' responsibilities to participants. Researchers modified their application and/or consulted their research ethics committee in response to the concerns, which had a positive/neutral impact on their given study. Anticipating concerns and improved collaboration between researchers and research ethics committees should protect the quality of suicide prevention research.

Dealing with Ethical Concerns in Suicide Research: A Survey of Australian Researchers

Given the increasing trend in suicide mortality and its burden on individuals, families and communities, ethically sound research is crucial to improve the prevention of suicidal behaviour. However, few studies have looked at the experiences of researchers in obtaining ethics approval for their studies. This study addressed this gap by investigating researchers’ experiences in obtaining ethics approval and how they dealt with the concerns raised by ethics committees. Respondents were recruited from September to November 2018 through the Australian Suicide Prevention Research Leaders Network, and 33 respondents (35%) completed the study survey, comprising forced-choice and open-ended questions. Respondents most commonly reported concerns from ethics committees regarding potential harm to participants and researchers’ responsibilities to participants within the context of intervention and evaluation studies. Most researchers modified their ethics application and/or consulted with their ethics committee to reply to the concerns raised. Most respondents perceived the impact of the modification as positive or neutral. The study concludes that researchers may anticipate potential concerns of ethics committees. Improved understanding of how ethics committees work and dialogue between researchers and ethics committees should sustain the quality in suicide-related research.

Effectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes

BACKGROUND

Suicide bereavement is a risk factor for adverse outcomes related to grief, social functioning, mental health and suicidal behaviour. Consequently, suicide bereavement support (i.e., postvention) has been identified as an important suicide prevention strategy. However, little is known about its effectiveness. To redress this gap, this review aimed to assess the evidence of effectiveness of interventions for people bereaved by suicide, and appraise the quality of the research in this field.

METHODS

We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, PsycINFO, Embase and EBM Reviews identified 12 papers reporting on 11 relevant studies conducted between 1984 and 2018.

RESULTS

Across studies, there was a wide variety of intervention modalities, study populations, control groups, and grief, psychosocial and suicide-related outcome measures. Overall, the quality of studies was weak. While there was some evidence of the effectiveness of interventions for uncomplicated grief, evidence of the effectiveness of complicated grief interventions was lacking. Based on this scant evidence, interventions which seem to show promise include supportive, therapeutic and educational approaches, involve the social environment of the bereaved, and comprise a series of sessions led by trained facilitators.

CONCLUSIONS

There is a clear need for additional methodologically sound studies in this area. Specifically, selection procedures, sample sizes, randomization, and the use of appropriate measures are crucial. As people bereaved by suicide are at-risk of adverse grief, mental ill-health and suicidal behaviour, further research across the life-span is essential to prevent grief and mental health ramifications.

The adolescent grief inventory: Development of a novel grief measurement

BACKGROUND

To develop an empirically derived, reliable and valid measure of grief in adolescents, aged 12-18 years old.

METHODS

An online survey comprising 59 items derived from a qualitative study of 39 bereaved adolescents, the Hogan Inventory of Bereavement Children and Adolescents (HIB), the Depression, Anxiety and Stress Scales (DASS-21), the Multidimensional Scale of Perceived Social Support (MSPSS), and a series of death- and mental health-related questions, targeted adolescents bereaved when aged 12-18 years, with 176 adolescents (80.6% girls) completing the survey.

RESULTS

Factor Analysis of the 59-items resulted in a final solution, the Adolescent Grief Inventory (AGI) comprised of 40 items and 6 factors: Sadness, Self-blame, Anxiety and Self-harm, Shock, Anger and Betrayal, and Sense of Peace, with indices of good fit (RMSEA = 0.057, CFI = 0.952, TLI = 0.948). There was strong evidence of convergent (HIB) and divergent (MSPSS) validity. Adolescents bereaved by suicide scored higher on Self-blame, Anger and Betrayal while those with a history of suicidal behaviour or having a mental health diagnosis scored higher overall than those who had not.

LIMITATIONS

Study limitations include the self-selected, mostly female, sample, a high proportion of participants with a mental health and self-harm history, and reliance on self-reported data.

CONCLUSIONS

The AGI is a novel, comprehensive and valid measure of grief in adolescents. It can be used broadly, including with bereaved adolescents at-risk of mental health ramifications.

"Don't bother about me." The grief and mental health of bereaved adolescents

Death of a relative or friend is a potentially disruptive event in the lives of adolescents. To provide targeted help, it is crucial to understand their grief and mental health experiences. Thematic analysis of 39 semistructured telephone interviews yielded two themes: Grieving apart together and Personal growth. High self-reliance and selective sharing were common. Feelings of guilt and "why" questions seemed more pronounced among the suicide bereaved. There was strong evidence of personal growth, increased maturity, and capacity to deal with personal mental health/suicidality. Despite its devastating effects, experiencing a death can be a catalyst for positive mental health.

Suicide on the Railways in Belgium: A Typology of Locations and Potential for Prevention

Suicide on railway networks comprises a serious public health problem. However, the geographical distribution and the environmental risk factors remain unclear. This study analyzed the geographic distribution of railway suicides in Belgium from 2008–2013 at the level of a railway section (average length of 3.5 km). Principal component analysis (PCA) identified three groups of correlations that helped explain the variance of railway suicide. The three groups are related to characteristics of urban spaces, psychiatric facilities, and railway traffic density. Based on the PCA results, the study found four types of railway sections. The density of railway suicide was average and low in the urban and rural/industrial sections, respectively. However, it was high in the suburban sections and the sections close to psychiatric facilities. As the geographical proximity of a psychiatric facility comprises a specific risk factor for suicide on railways, preventative measures should target these sections and establish collaborations with psychiatric facilities. The typology of locations found in this study constitutes crucial information for national and local suicide prevention on the Belgian railway network.

A Systematic Mapping of Suicide Bereavement and Postvention Research and a Proposed Strategic Research Agenda

Abstract. Background: Suicide may have disruptive and/or devastating effects on family, friends, and the broader community. Of late, increased interest from suicide researchers has given rise to an upsurge in research productivity addressing suicide bereavement and postvention. At this critical juncture, the establishment of an agenda will help guide the direction of future scholarly research in this field. Aims: To conduct an exhaustive systematic mapping review and bibliometric analysis of peer-reviewed suicide bereavement and postvention research published over the past 50 years. Method: A comprehensive and strategic search of electronic databases and web-based search engines for original research studies was conducted resulting in the identification of 443 articles. Results: Since 1965, the global research activities in the field of suicide bereavement and postvention is approximately 8.86 papers per year. There remains a lack of evaluation studies on the effects of interventions/programs with the majority of papers being explanatory in nature. Several areas of study within this field remain neglected. Limitations: While the search strategy was rigorous, potential limitations exist due to nonstandardized nomenclature and English language only inclusion, which inherently favors research from high-income countries. Conclusion: Suggested topics for a research agenda are proposed from the current limitations in the field.

Harmful or Helpful? A Systematic Review of How Those Bereaved Through Suicide Experience Research Participation

BACKGROUND

Many of the bereaved through suicide are interested in participating in postvention studies. However, there is a contradiction between the positive experiences of research participation and concerns raised by ethical boards.

AIMS

To review studies on the experience of research participation by those bereaved through suicide, including initial contact with the study and its short- and long-term impacts.

METHOD

Systematic searches in Embase, Medline, PsycINFO, as well as Google Scholar identified 12 papers reporting on 11 studies.

RESULTS

The majority (73-100%) of study participants evaluated participation positively, and would recommend it to others (90-100%), as it was related to altruism, social support, and personal growth. A minority experienced participation as negative (2-10%) or upsetting (5-22%) due to feelings of guilt or painful memories. However, having a painful experience does not preclude seeing it as helpful.

LIMITATIONS

Most studies concerned face-to-face psychological autopsy studies, and only two studies included a control group.

CONCLUSION

Research applying standardized measures may enhance our understanding of the factors germane to (non-)participation and to the likelihood of a positive/negative research experience. Vigilant recruitment and providing optimum care for participants are indicated. Further research may continue to improve participant safety and the research design of suicide bereavement studies.

Help-seeking experiences of bereaved adolescents: A qualitative study

Despite the potentially devastating effects of a death on the lives of adolescents, little is known about their help-seeking experiences. We interviewed by telephone 39 bereaved adolescents on their help-seeking experiences. Thematic analysis resulted in three themes: Formal support, Informal support and School-related support. Participants provided a critical appraisal of positive and negative experiences, and noted barriers and facilitators for help-seeking. As adolescents bereaved through suicide may receive less social support, professional help is a much-needed auxiliary. Parental encouragement is important in accessing adequate professional help.

Depression, Hopelessness, and Complicated Grief in Survivors of Suicide

Suicide often has a severe impact on the surviving family and friends. There is a need to better understand the psychological and psychopathological consequences of losing a significant other by suicide. The aim of the present study was to assess hopelessness, depression, suicide risk, complicated grief, intrusive memories, and avoidance in a sample of suicide survivors. In this observational study, 35 bereaved individuals were recruited at the Suicide Prevention Centre of Sant’Andrea Hospital in Rome. Individuals were administered a series of validated instruments: the Beck Depression Inventory II (BDI), the Beck Hopelessness Scale (BHS), the Inventory of Complicated Grief (ICG), the Impact of Event Scale (IES), the Subjective Happiness Scale (SHS), and the Satisfaction With Life Scale (SWLS). Most survivors (62.8%) obtained high scores on measures of complicated grief. Scores on the measure of complicated grief were associated with intrusiveness of thoughts and memories, attempts to prevent the thoughts and emotions related to the event, depressive symptoms and hopelessness, and lower scores for feelings of happiness and satisfaction with life. A subgroup of suicide survivors may be at risk of severe psychological distress and suicidal behavior. Identification of these survivors is a necessary step for providing appropriate counseling and psychotherapy.

A Mapping Study on the Internet and Suicide

Abstract. Background: Since the mid-1990s concerns have been raised regarding the possible links between suicide and the Internet, especially among adolescents and young adults. Aims: To identify the nature and extent of the scientific publications, especially original research studies, on suicide and the Internet, and to investigate how the field has developed over time. In particular, this mapping study looks at types of publications, topic areas, focus of original research papers, and suicide-related variables of interest in publications. Method: A search of three major databases (PubMED, PsycINFO, and Sociological Abstracts) was conducted to identify papers published until the end of January 2015. Results: The study identified 237 publications on suicide and the Internet published from 1997 to the end of January 2015. These included 122 original research papers. The three most frequent topic areas covered in publications were searching for information on suicide, online interventions, and online suicide-related behaviors. The online mediums most frequently studied were online forums/message boards, search engines, intervention and information websites, and social media. Limitations: The mapping study did not include an analysis of results of research studies and did not assess their quality. Conclusion: The field is rapidly evolving, as seen in the recent increase in the number of publications. However, there are gaps in terms of the countries where research is conducted and the coverage of topics.

Prevalence of exposure to suicide: A meta-analysis of population-based studies

Those exposed to suicide are at increased risk of adverse outcomes including mental illness, impaired social functioning, and fatal and non-fatal suicidal behavior. However, it is unclear how many people are exposed to suicide in the general community. This first meta-analysis of population-based studies aimed to provide pooled estimates of past-year and lifetime prevalence of exposure to suicide among family, friends/peers, and all relationships. In addition, the study examined prevalence of exposure to suicide by age group: adolescents and adults. Systematic searches of the literature in Embase, Medline and PsycINFO identified eighteen studies that were included in the analysis. Pooled past-year prevalence was 4.31% (CI: 2.50 to 6.58) and life-time prevalence 21.83% (CI: 16.32 to 27.90). Both past-year and lifetime prevalences of exposure to suicide among friends and peers were significantly higher than the prevalence of exposure within families; there were no differences in the prevalence of exposure to suicide between adolescents and adults. Heterogeneity was highly significant. Future research should be conducted with large national representative samples and use standardised assessment instruments. Given the increased risks of adverse outcomes among those exposed to suicide, the high rate of exposure to suicide reported here has important ramifications for public health and mental health service delivery.

Current Postvention Research and Priorities for the Future

Abstract. Background: Suicide can have a lasting impact on the social life as well as the physical and mental health of the bereaved. Targeted research is needed to better understand the nature of suicide bereavement and the effectiveness of support. Aims: To take stock of ongoing studies, and to inquire about future research priorities regarding suicide bereavement and postvention. Method: In March 2015, an online survey was widely disseminated in the suicidology community. Results: The questionnaire was accessed 77 times, and 22 records were included in the analysis. The respondents provided valuable information regarding current research projects and recommendations for the future. Limitations: Bearing in mind the modest number of replies, all from respondents in Westernized countries, it is not known how representative the findings are. Conclusion: The survey generated three strategies for future postvention research: increase intercultural collaboration, increase theory-driven research, and build bonds between research and practice. Future surveys should include experiences with obtaining research grants and ethical approval for postvention studies.

Suicide bereavement and postvention in major suicidology journals: lessons learned for the future of postvention

BACKGROUND

Since the seminal publications of Shneidman (1969) and Cain (1972), suicide bereavement and postvention have attracted increasing research interest.

AIMS

To examine the topics of suicide bereavement and postvention in the core international suicidology journals, since their inception until mid-2013, in order to reveal the number of postvention articles throughout the years, their geographic distribution, and the topics of suicide bereavement and postvention that have been published.

METHOD

The online databases of four journals (Crisis, The Journal of Crisis Intervention and Suicide Prevention; Suicide and Life-Threatening Behavior [SLTB]; Archives of Suicide Research; and Suicidology Online) as well as the tables of content of all issues were searched. The number of articles and the countries of origin were quantified, and articles were categorized according to their content.

RESULTS

The search identified 144 postvention articles, published during the past 40 years, almost exclusively in two journals (Crisis and SLTB). The majority of articles were (co-)authored by authors from Anglo-Saxon, Western countries. Articles were categorized in three groups: characteristics of suicide bereavement (n = 73), postvention programs (n = 66), and definition/theory and epidemiology of survivors (n = 5).

CONCLUSION

Articles on suicide bereavement and postvention have been published mostly in two suicidology journals, albeit in modest numbers, and from a limited number of mostly Western countries. Our understanding of suicide bereavement and the provision of survivor support might benefit from the development of consensual definitions and from studies in other parts of the world.

Geographic distribution of suicide and railway suicide in Belgium, 2008-2013: a principal component analysis

This study investigated the geographic distribution of suicide and railway suicide in Belgium over 2008--2013 on local (i.e., district or arrondissement) level. There were differences in the regional distribution of suicide and railway suicides in Belgium over the study period. Principal component analysis identified three groups of correlations among population variables and socio-economic indicators, such as population density, unemployment, and age group distribution, on two components that helped explaining the variance of railway suicide at a local (arrondissement) level. This information is of particular importance to prevent suicides in high-risk areas on the Belgian railway network.

Pre- and postloss features of adolescent suicide bereavement: A systematic review

Despite increasing clinical and research interest in suicide bereavement the impact of suicide on adolescents is still poorly understood. This systematic review aims to disentangle pre- and postloss features that affect response to grief in this age group. The literature was analyzed after a systematic search and hand-check of retrieved articles. The impact of suicide is affected by (a) preloss features related to personal/family history of mental health, family life, suicidal behavior, and type and emotional closeness of relationship; and (b) postloss issues such as quality of remaining relationships. Future research and bereavement support should consider these broader contexts.

Online Memorialization and Grief After Suicide: An Analysis of Suicide Memorials on the Internet

Although several studies have looked at the phenomenon of online memorialization, online involvement of those bereaved by suicide (suicide survivors) remains an under-studied area. The current study analyzed 250 memorials dedicated to those who died by suicide on two memorialization Web sites: Faces of Suicide and Gone too Soon. The majority of the memorials was posted by family members of the deceased and had a format of a letter or an obituary. Though the memorials were written for both males and females of all ages, 80% of the messages were written for young males. Fourteen themes were identified, ranging from sadness and expressions of love and other grief reactions of the bereaved, to acknowledgment of suicide and search for reasons for the death. Some of the bereaved wrote about their motives for posting an online memorial. Future studies should determine the impact of involvement in online memorialization on the grief process of suicide survivors.

Predictors of article impact in suicidology: the bereavement literature, a research note

Citation analysis has been neglected in suicidology. The present note applies a mixed-methods approach to both test and suggest hypotheses for the variation in article impact in the bereavement literature. One hundred three articles from three core suicidology journals met the criteria for inclusion in the investigation. Citations to the articles were obtained from the Web of Science. Predictor variables included structural characteristics of the author (e.g., gender) and the article itself (e.g., years since publication). A multivariate regression analysis determined that, controlling for the other variables, the most important predictor of citations was the review article (β = .461), followed by year of publication (β = -.414), the multiauthored article (β = .302), publication in Suicide and Life-Threatening Behavior (SLTB) (β = .161), and male gender (β = .156). The 12 most cited articles were published between 1979 and 2004 in SLTB. The majority of these papers was written by males, were U.S. authors, and had more than one author. Four of the most cited articles were reviews. The study concludes that structural characteristics of articles and authors explained 41% of the variance in citations. The qualitative analysis determined that review papers, and papers on characteristics of suicide bereavement and psychological autopsies have been most frequently cited. Replication studies are needed for other subfields of suicidology.

Religion and spirituality in online suicide bereavement: an analysis of online memorials

BACKGROUND

Religion and spirituality can be valuable resources in coping with bereavement. There is a paucity of studies focusing specifically on their role in suicide bereavement, although there are indications that religion/spirituality can be helpful for suicide survivors.

AIMS

The study explores the role of religion and/or spirituality in suicide bereavement by analyzing this theme in online memorials dedicated to suicide victims.

METHOD

We randomly selected 250 memorials in two online cemeteries: Faces of Suicide and Gone too Soon. Interpretative and deductive thematic analysis was used to identify themes in the collected material, including the theme of religion/spirituality.

RESULTS

References to religion/spirituality were found in 14% of memorials. These memorials were written by family members, friends, and (ex-)partners of the deceased and were dedicated mostly to young adult males. Religion/spirituality was mentioned in the context of God's will, peace wish, continuation of the spirit, afterlife, reunion, gratitude, description of the deceased, and grief reactions of suicide survivors.

CONCLUSION

Some suicide survivors spontaneously mention the role of religious/spiritual beliefs in coping with their loss. Future studies could explore which subgroups of the bereaved are likely to turn to these resources, and whether they can contribute to the well-being of the suicide survivors.

Railway Suicide in Belgium 1998–2009

Background: Belgium is a country with a high suicide rate (19.1/100,000 in 2004), and railway suicide poses a substantial safety and public health problem. This problem was addressed by the Suicide Prevention Unit of Infrabel (Manager of the Belgian Railway Infrastructure), which collects relevant data and implements a prevention program. Aims: To present data on fatal and nonfatal suicidal behavior on the Belgian railway network, including monthly and regional distribution and identification of hotspots; and to present the Infrabel suicide prevention program. Methods: Analysis of Infrabel data on railway suicide (1998–2009) and comparison with data on suicide in Belgium. Results: A total of 1,092 railway suicides (1998–2009) and 557 suicide attempts (2003–2009) in Belgium (fatality rate of 54%) were studied. Monthly fluctuations were observed, with the majority of suicides occurring in Flanders, followed by Wallonia and Brussels. We identified 34 hotspots accounting for 35% of cases, mostly in Flanders. Conclusions: In 2004 railway suicide accounted for 5.3% of all suicides in Belgium (railway suicide rate of 1.03/100,000). Such a major human and economic loss warrants implementation of prevention measures. Infrabel has initiated a comprehensive suicide prevention program which focuses mainly on safeguarding the suicide hotspots.

Essential questions on suicide bereavement and postvention

During the past decades public and research interest in postvention, i.e., support for families and communities after a suicide, has increased. However, the postvention field is still facing a number of important challenges and questions. This article aims to discuss a series of essential issues on suicide bereavement and postvention, regarding the current state of the art and future developments. Who is a suicide survivor and how many suicide survivors are there? Is suicide bereavement different from other types of bereavement? What are the needs of suicide survivors and what is postvention from a clinical perspective and from a public health perspective? Can postvention be prevention? With this last question, the article concludes with a series of recommendations in order to strengthen the potential of postvention as prevention.

On-line support and resources for people bereaved through suicide: what is available?

The Internet is a potentially valuable source of information for the bereaved, but the current knowledge regarding the type and quality of online material on suicide bereavement is very limited. This study was designed to explore the types of online information and support available for people bereaved by suicide and the quality of such resources. Four popular Internet search engines were searched using terms related to suicide bereavement and support. Although a wide range of Internet resources exist for people bereaved by suicide, these resources may not meet basic quality standards. It is unknown who uses these sites, how such material is used, and whether it helps people to cope effectively with grief after suicide.

Suicide intervention skills and related factors in community and health professionals

Health and community professionals have considerable exposure to suicidal people and need to be well skilled to deal with them. We assessed suicide intervention skills with a Dutch version of the SIRI in 980 health and community professionals and psychology students. Suicide intervention skills clearly differed among professional groups and were strongly related to experience, especially suicide-specific experience. Some community professionals scored below acceptable levels on their ability to respond appropriately to suicidal people they encounter, and tended to overestimate their skills level. Training is therefore indicated for these groups, and may be useful to more highly experienced groups too.

Can sports events affect suicidal behavior? A review of the literature and implications for prevention

BACKGROUND

Engagement in sports and physical activity, either actively as an athlete or in a passive way as a spectator, impacts interpersonal behavior and physical and mental health.

AIMS

The study reviews literature on the relationship between sports spectatorship and suicidal behavior to ascertain whether sports spectatorship has an impact on suicidal behavior, either increasing the risk or being a protective factor.

METHODS

The literature was searched via PubMed/MEDLINE and PsycINFO. Nine studies published between 1986 and 2006 were identified.

RESULTS

The reviewed studies focused on the impact of sports events on the societal level, and analyzed data regarding national or local suicide rates. Their results indicate that sports events can have an impact on suicide mortality and morbidity, but this relationship seems to be mediated by age, gender, marital status, and alcohol consumption, as well as the process and outcome of the game (e.g., victory vs. defeat of the favored team).

CONCLUSIONS

There is some evidence that sports events can reduce the rates of suicide on the societal level; however, there is a lack of studies exploring how sports spectatorship might influence levels of suicide risk in individuals and how mediating variables might operate on the individual level.

Can Postvention Be Prevention?

Background. There has been recent interest in postvention activities which involve provision of support to family members and others affected by a suicide death. Aims. To review the current status of postvention support, including definitions used and the objectives and effectiveness of support activities for people bereaved by suicide. Methods. Selected controlled studies of support activities and programs are reviewed with narrative comment. Results. Not applicable. Conclusions. Effective postvention support can be viewed as contributing toward suicide prevention among those people who are bereaved by suicide. Further development of support programs is needed.

Two further comments on Durkheim's Le Suicide

It appears that the publications of Goldney and Schioldann (2000, 2001a,b, 2002) touched a chord, namely, the quality of the basic literature of contemporary suicidology and the usage of certain words and concepts. This paper adds two comments to this discussion. The first comment focuses on the usage of "altruistic," "egoistic," and "anomic" suicide. The second is a comment on the reception of Le Suicide.

Current Understandings of Suicide Survivor Issues: Research, Practice, and Plans

The goals of the Postvention Taskforce of the International Association for Suicide Prevention (IASP) are to increase awareness of postvention and survivor issues. One of the strategies is to organize meetings. We report on the 1st International Suicide Postvention Seminar, held as a 1-day preevent at the 11th European Symposium on Suicide and Suicidal Behavior in Portoroz, Slovenia, September 2006. The seminar provided a state of the art review of the postvention field, with plenary presentations on research, psychotherapeutic care, development of national networks, and of postvention materials. We summarize the presentations below.

On "intention" in the definition of suicide

The need for a comprehensive nomenclature in suicidology is now well recognized. In this paper the focus is on the issue of intention, which is identified as an essential aspect of any definition of suicide and suicidal behavior primarily because of its distinction from accidental behavior. The distinction between the retrospective perspective of motives versus the prospective perspective of intentions is highlighted, and I argue that the latter is more closely related to suicidal behavior. Finally, while motives and intentions tend to be used together in research, there is a need for sound research to clarify the roles of intentions in order to better understand suicide and attempted suicide.

What Helps and What Hinders the Process of Surviving the Suicide of Somebody Close?

Abstract: This paper presents similar findings about the lack of support and understanding for people bereaved through suicide from four different countries and reports on each country's unique response to this challenge. This paper reports on presentations made at the conference workshop of the International Association for Suicide Prevention meeting in Chennai in 2001, and on participants' suggestions of how best to help the bereaved.

Networking to support suicide survivors

This paper is the first report on a national program for increasing bereavement support for suicide survivors in the Flemish region in Belgium. A Working Group consisting of representatives of a wide variety of mental health institutions, social programs, and suicide survivor groups in the area determined that a program developing networks between the services seems to hold the greatest promise for both an increase in the number of services available and an improvement in the quality of services offered.

Networking to Support Suicide Survivors

Summary: This paper is the first report on a national program for increasing bereavement support for suicide survivors in the Flemish region in Belgium. A Working Group consisting of representatives of a wide variety of mental health institutions, social programs, and suicide survivor groups in the area determined that a program developing networks between the services seems to hold the greatest promise for both an increase in the number of services available and an improvement in the quality of services offered.