Cost-effectiveness of media reporting guidelines for the prevention of suicide

INTRODUCTION

Media guidelines for the responsible reporting of suicide are a recognized universal suicide prevention intervention. While implemented in numerous countries, including Australia, little is known about whether they are cost-effective. We aimed to determine the cost-effectiveness of Mindframe, the national initiative implementing media guidelines in Australia.

METHOD

We conducted a modelled economic evaluation (5-year time-horizon) incorporating two types of economic analysis: (i) return-on-investment (ROI) comparing estimated cost savings from the intervention to the total intervention cost, and (ii) cost-effectiveness analysis comparing the net intervention costs to health outcomes: suicide deaths prevented and quality-adjusted life-years (QALYs). We also included uncertainty analyses to propagate parameter uncertainty and sensitivity analyses to test the robustness of the model outputs to changes in input parameters and assumptions.

RESULTS

The estimated ROI ratio for the main analysis was 94:1 (95% uncertainty interval [UI]: 37 to 170). The intervention was associated with cost savings of A$596M (95% UI: A$228M to A$1,081M), 139 (95% UI: 55 to 252) suicides prevented and 107 (95% UI: 42 to 192) QALYs gained. The intervention was dominant, or cost-saving, compared with no intervention with results being robust to sensitivity analysis but varying based on the conservativeness of the parameters entered.

CONCLUSION

Mindframe was found to be cost-saving, and therefore, worthy of investment and inclusion as part of national suicide prevention strategies.

Association between Grief and Somatic Complaints in Bereaved University and College Students

Many emerging adults experience the death of a loved one while they are enrolled as a student in higher education. Bereavement increases the risk of long-term adverse physical and mental health outcomes. Still, as most studies have focused on psychological aspects of grief, little is known about the impact of grief on somatic complaints in students, leaving them vulnerable to health deteriorations. This study aimed to address this gap, and we hypothesized that there is a positive association between grief and somatic complaints in bereaved students. Participants (N = 688) were students enrolled at Flemish universities and colleges in Belgium. Participants filled out an online survey with sociodemographic questions, two scales assessing grief, and somatic grief reactions, and two additional questions inquiring whether participants had experienced other somatic reactions, and whether they had taken any steps to remedy their somatic complaints. Regression analyses revealed that less social support, type of relationship (first-degree relative), and the level of grief were positively associated with somatic complaints, and bereaved students reported various complaints such as feeling pain and strains, thus confirming the hypothesis. As bereaved students may be reluctant to seek support for somatic complaints, the findings indicate that information and psychoeducation for bereaved students and their social environment must address somatic grief reactions and encourage timely help seeking. In addition, staff members at psychosocial and medical services for students should be trained to recognize somatic as well as psychological grief reactions. Appropriately skilled, they can inquire about such complaints and provide adequate support to prevent long-term health ramifications.

Ethical Issues in Bereavement Research with Minors: A Scoping Review

There are various ethical issues in bereavement research. Most of the literature focuses on ethical issues involving adult participants. However, it is conceivable that research with minors poses particular ethical challenges, and little is known of the ethical issues involved in bereavement research with minors. A scoping review adhering to the PRISMA-ScR guidelines was conducted to address this gap and to contribute to better research practices. Searches in Embase, Emcare, EBM Reviews, Medline, PsycINFO (all accessed via Ovid), CINAHL, Scopus, SSCI, and the journals Death Studies and OMEGA identified 40 relevant peer-reviewed articles, while 25 relevant theses/dissertations were identified through ProQuest Global. The main ethical concerns identified include informed consent, risk to participants, and privacy and confidentiality. Findings of this review may inform bereavement researchers when designing their studies and to ensure the safety of their participants. The findings can also be used in clarifying the decisions made to a research ethics board, thus contributing to the quality of the research in this field. Future reviews may examine how the ethical issues reported in this review are similar or different to those reported in research with minors in other fields and expand to include more experimental research.

Help-seeking behavior in bereaved university and college students: Associations with grief, mental health distress, and personal growth

Many students have experienced the death of a loved one, which increases their risk of grief and mental health problems. Formal and social support can contribute to better coping skills and personal growth in bereaved students. The purpose of this study was to examine the support that students received or wanted to receive and its relation to students’ mental health. We also looked at students’ needs when receiving support and barriers in seeking formal and social support. Participants (N = 666) completed an online survey consisting of questions about their sociodemographic characteristics, the support they received or wanted to receive, and support needs and barriers in seeking support. The survey also included three scales assessing grief, mental health distress, and personal growth. First, we analyzed the data descriptively. Next, we used MANCOVA to examine whether students who did or did not receive or wanted more support differed in terms of their grief, mental health distress, or personal growth. About 30% of students needed more support and experienced more grief and mental health distress than students who had their support needs met. Students who received support experienced more personal growth and grief than students who did not receive support. Students indicated a need for feeling acknowledged and safe. Feeling like a burden to others and perceiving their problems as not serious enough to warrant support were common barriers to seeking support. Our results indicate that support should be provided actively to students after the death of a loved one, and support being available on an ongoing basis.

Perspectives on family-based suicide prevention and postvention

Suicide remains an important public health problem worldwide. Many countries have developed national suicide prevention policies or guidelines, which often include family-based recommendations regarding suicide prevention, intervention or postvention. A recent systematic review, published in this journal, failed to find evidence of an impact of family-based recommendations in national guidelines on national suicide rates. In this editorial, we review other studies providing promising evidence of effectiveness of family-based interventions in the field of suicide prevention and postvention, and note that further studies are needed, especially in adult and older adult populations.

Anticipated Self and Public Stigma in Suicide Prevention Professionals

Background

Stigma about mental illness-both public and self-is one of the most important factors hindering help-seeking. Stigma can occur during an acute episode of mental illness or be anticipatory. One group affected by stigma, but often neglected, is mental health professionals. This study examined the anticipated form of mental-illness and help-seeking self-stigma and the anticipated form of public stigma of suicidal behavior among members of the International Association for Suicide Prevention. We hypothesized that suicidologists with a history of suicidality or mental illness would anticipate greater stigma from the public and self.

Methods

The study received ethical approval from the Commission for Medical Ethics of the Republic of Slovenia. Data from 83 participants who completed an online survey (February to May 2020) with informed consent were analyzed using path analysis. We tested a model predicting help-seeking self-stigma based on (i) personal experience of mental illness using anticipated self-stigma of mental illness as a mediating variable and (ii) history of suicidal behavior using anticipated public stigma of suicidal behavior as a mediating variable.

Results

Personal experience of mental illness predicted anticipation of self-stigma of mental illness (β = 0.26). History of suicidality predicted anticipation of public stigma of suicidal behavior (β = 0.29). Anticipated self-stigma of mental illness proved to be a stronger predictor of help-seeking self-stigma (β = 0.40) than anticipated public stigma of suicidal behavior (β = 0.07).

Conclusions

It is important to intentionally support the mental health of suicide prevention professionals, as they are not immune to mental illness or various types of stigma. Because our sample was small and diverse, further research to better understand stigma concepts in this population is warranted.

A Systematic Review of the Experiences and Support Needs of Informal Caregivers for People Who Have Attempted Suicide or Experienced Suicidal Ideation

Informal caregivers include family, friends, and significant others who provide important support for people who have attempted suicide or experienced suicidal ideation. Despite the prevalence of suicidal behaviour worldwide, they remain an understudied population. This review aimed to synthesise the literature on the experiences and support needs of informal caregivers of people who have attempted suicide or experienced suicidal ideation. We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, Emcare, Embase, EBM Reviews, and PsycINFO identified 21 studies (4 quantitative and 17 qualitative), published between 1986 and 2021. Informal carers commonly reported symptoms of depression and anxiety, for which they receive little assistance. They also expressed a desire for more involvement and education in the professional care of suicidality. Together, the studies indicated a need to improve the way informal caregiving is managed in professional healthcare settings. This review identified potential avenues for future research, as well as broad areas which require attention in seeking to improve the care of suicidal people and their caregivers.

A review of Australian Government funding of parenting intervention research

OBJECTIVES

Parenting is central to children's optimal development and accounts for a substantial proportion of the variance in child outcomes, including up to 40% of child mental health. Parenting is also one of the most modifiable, proximal, and direct factors for preventing and treating a range of children's problems and enhancing wellbeing. To determine the effectiveness of new approaches to parenting intervention, and to evaluate how to optimise reach and uptake, sufficient funding must be allocated for high quality research.

METHOD

We reviewed funding awarded by the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) for parenting intervention research during 2011-2020.

RESULTS

Parenting intervention research received 0.25% of the NHMRC and ARC research budgets.

CONCLUSIONS

There is a substantial mismatch between the funding of parenting intervention research and the impact of improved parenting on short- and long-term child outcomes. To rectify this, it is critical that Australian Government funding schemes include parenting interventions as priority areas for funding.

IMPLICATIONS FOR PUBLIC HEALTH

Changes in allocation of funding to parenting research will support the establishment of evidence for the effective development, implementation and dissemination of parenting interventions to maximise health outcomes for children and their families.

Personal growth in bereaved students: Associations with support, grief, and distress

Experiencing the death of a loved one can have a substantial negative impact on the grief and mental health of students. However, the bereavement can also lead to personal growth. We investigated the association between personal growth and support, grief, and distress. Bereaved students (N = 666) at Flemish universities and colleges (Belgium) completed an online survey with sociodemographic questions and four scales assessing personal growth, support, grief, and distress. Support and grief positively predicted personal growth. Emotional closeness correlated positively with personal growth. Our findings indicate a need for supporting bereaved students in their process of personal growth.

Cost-effectiveness of Installing Barriers at Bridge and Cliff Sites for Suicide Prevention in Australia

IMPORTANCE

Installation of barriers has been shown to reduce suicides. To our knowledge, no studies have evaluated the cost-effectiveness of installing barriers at multiple bridge and cliff sites where suicides are known to occur.

OBJECTIVE

To examine the cost-effectiveness of installing barriers at bridge and cliff sites throughout Australia.

DESIGN, SETTING, AND PARTICIPANTS

This economic evaluation used an economic model to examine the costs, costs saved, and reductions in suicides if barriers were installed across identified bridge and cliff sites over 5 and 10 years. Specific and accessible bridge and cliff sites across Australia that reported 2 or more suicides over a 5-year period were identified for analysis. A partial societal perspective (including intervention costs and monetary value associated with preventing suicide deaths) was adopted in the development of the model.

INTERVENTIONS

Barriers installed at bridge and cliff sites.

MAIN OUTCOMES AND MEASURES

Primary outcome was return on investment (ROI) comparing cost savings with intervention costs. Secondary outcomes included incremental cost-effectiveness ratio (ICER), comprising the difference in costs between installation of barriers and no installation of barriers divided by the difference in reduction of suicide cases. Uncertainty and sensitivity analyses were undertaken to examine the association of changes in suicide rates with barrier installation, adjustments to the value of statistical life, and changes in maintenance costs of barriers.

RESULTS

A total of 7 bridges and 19 cliff sites were included in the model. If barriers were installed at bridge sites, an estimated US $145 million (95% uncertainty interval [UI], $90 to $160 million) could be saved in prevented suicides over 5 years, and US $270 million (95% UI, $176 to $298 million) over 10 years. The estimated ROI ratio for building barriers over 10 years at bridges was 2.4 (95% UI, 1.5 to 2.7); the results for cliff sites were not significant (ROI, 2.0; 95% UI, -1.1 to 3.8). The ICER indicated monetary savings due to averted suicides over the intervention cost for bridges, although evidence for similar savings was not significant for cliffs. Results were robust in all sensitivity analyses except when the value of statistical life-year over 5 or 10 years only was used.

CONCLUSIONS AND RELEVANCE

In an economic analysis, barriers were a cost-effective suicide prevention intervention at bridge sites. Further research is required for cliff sites.

Ethical Issues to Consider in Designing Suicide Prevention Studies: An Expert Consensus Study

AIM

Research is imperative to advance our understanding of suicidal behavior and its prevention. Suicide prevention research involves various ethical issues, many of which are not straightforward to address. Hence, suicide prevention researchers sometimes face particular issues when designing their research studies. This expert consensus study aimed to identify the most important ethical issues to consider when designing suicide prevention studies.

METHODS

People with lived experience of suicide (N = 32) and suicide prevention researchers (N = 34) rated 80 statements on a 5-point Likert scale from "essential" to "should not be included."

RESULTS

There was significant agreement between and within the two groups of participants with regard to the most highly rated statements. The most highly rated statements for both groups included the importance of the ethical principles of merit, integrity, justice, and beneficence. Additionally, lived experience participants placed emphasis on the support and care for researchers, and suicide prevention researchers placed emphasis on the risk management protocols and support services for participants.

CONCLUSION

There was strong agreement between people with lived experience of suicide and suicide prevention researchers regarding what to consider when designing ethically sound suicide prevention research, including the importance of ethical principles and support for both participants and researchers.HIGHLIGHTSThere was strong agreement between people with lived experience of suicide and researchers.Researchers emphasized adherence to national guidelines.People with lived experience of suicide valued care for study participants and researchers.

Exploring experiences of supports for suicide bereavement in Ireland: protocol for a national survey

Background

A suicide death impacts upon the wellbeing of close family members and friends but has also been shown to affect many people outside of this immediate circle. This will be the first large-scale national study of adults bereaved or affected by suicide in Ireland, using a cross-sectional online survey. The overarching aim will be to gain insight into the experiences of supports received by people bereaved or affected by suicide and to identify the barriers to engagement following their loss.

Methods

A cross-sectional survey will be conducted among adults in Ireland who have been bereaved or affected by suicide. This project will seek to represent people with different demographics and backgrounds in the Irish population using a multifaceted approach to survey recruitment. A range of validated measures will be used to examine participants’ current wellbeing and grief experience. A combination of closed and open-ended questions will provide participants the opportunity to share their individual experiences, the services and supports available to them, and barriers and enablers to accessing supports.

Results

Quantitative data will be analysed using descriptive statistics. Chi-squared tests will be used to compare subgroups within categorical data items, and multivariable regression models will be used to examine differences in psychosocial and physical wellbeing across key groups. Qualitative content analysis will be used for qualitative responses to open-ended questions.

Conclusions

The survey will provide an in-depth understanding of the psychosocial and mental health impacts of suicide bereavement in Ireland; insight into the range of informal and formal supports accessed; and will identify unmet needs and challenges of accessing appropriate and timely supports. The findings will inform current national actions aimed at ensuring the standardisation and quality of the services and supports for those bereaved or affected by suicide.

The Reactions of Adolescents, Parents and Clinicians to Participating in Qualitative Research Interviews Regarding Adolescents Bereaved by Suicide and Other Traumatic Death

There are concerns that involving adolescents bereaved by suicide and other traumatic death in research may cause distress and harm. However, no study has investigated such bereaved adolescents’ research experiences. In addition, no study has looked at the experiences of parents and clinicians as participants in adolescent suicide and traumatic death bereavement research. This study aimed to explore the short-term impact of research participation experienced by adolescents, parents, and clinicians. A total of 61 participants (adolescents, n = 17; parents, n = 12; clinicians, n = 32) filled out a short survey within two weeks of having taken part in a qualitative interview study. Data were analyzed descriptively. Most participants had experienced no distress while participating and no negative effects of participating; rather, participation was experienced as helpful for them and they would highly recommend participating in a study like this to others. A few adolescents and parents reported some distress, related to anxiety about participation and the unpleasantness of grief memories. The study clearly indicates that bereaved adolescents, parents and clinicians can safely participate in research interviews regarding their experiences of grief and help after suicide, generally valuing the opportunity to share their experience. To prevent and mitigate potential distress, training of research staff and implementation of appropriate participant distress protocols are imperative. Future studies could include longitudinal follow-up of participants to assess any longer-term consequences.

Exploring experiences of supports for suicide bereavement in Ireland: protocol for a national survey

Background A suicide death impacts upon the wellbeing of close family members and friends but has also been shown to affect many people outside of this immediate circle. This will be the first large-scale national study of adults bereaved or affected by suicide in Ireland, using a cross-sectional online survey. The overarching aim will be to gain insight into the experiences of supports received by people bereaved or affected by suicide and to identify the barriers to engagement following their loss. Methods A cross-sectional survey will be conducted among adults in Ireland who have been bereaved or affected by suicide. This project will seek to represent people with different demographics and backgrounds in the Irish population using a multifaceted approach to survey recruitment. A range of validated measures will be used to examine participants' current wellbeing and grief experience. A combination of closed and open-ended questions will provide participants the opportunity to share their individual experiences, the services and supports available to them, and barriers and enablers to accessing supports. Results Quantitative data will be analysed using descriptive statistics. Chi-squared tests will be used to compare subgroups within categorical data items, and multivariable regression models will be used to examine differences in psychosocial and physical wellbeing across key groups. Qualitative content analysis will be used for qualitative responses to open-ended questions. Conclusions The survey will provide an in-depth understanding of the psychosocial and mental health impacts of suicide bereavement in Ireland; insight into the range of informal and formal supports accessed; and will identify unmet needs and challenges of accessing appropriate and timely supports. The findings will inform current national actions aimed at ensuring the standardisation and quality of the services and supports for those bereaved or affected by suicide.

Bereavement and educational outcomes in children and young people: A systematic review

Experiencing bereavement due to the death of a close person is rife in the lives of young people. This review aimed to investigate how bereavement affects educational outcomes of students at various educational levels and what factors may be involved in moderating these outcomes. The systemic review was conducted according to the PRISMA guidelines with searches of peer-reviewed literature in Embase, Emcare, Medline, PsycINFO and Scopus. Twenty-two studies (17 quantitative and 5 qualitative) were included. In general, bereavement can constitute a barrier to educational achievement in young people compromising academic performance, and educational engagement and attainment. Several factors can place young people at greater risk of experiencing this disadvantage and further research into these mechanisms and interventions to mitigate short- and long-term consequences, especially among high-risk groups, is warranted.

How best to provide help to bereaved adolescents: a Delphi consensus study

BACKGROUND

Many adolescents struggle with their grief and mental health issues after the death of a close person, such as a family member or a friend. Given the potentially devastating impact of the loss on the adolescent and their family, professional help can be warranted. However, little is known about how to best help these adolescents. This study aimed to address this gap by determining what help professionals (i.e., counselors) should provide to bereaved adolescents.

METHODS

The Delphi method was used to achieve consensus regarding the importance of statements that describe actions a helping professional can take to help a bereaved adolescent. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing interview data from a recent related research study with bereaved adolescents, parents and counselors. An expert panel (N = 49) comprising 16 adolescents, 14 parents and 19 helping professionals, rated each statement. Statements that were endorsed by at least 80% of panellists were considered consensus recommendations.

RESULTS

Panellists endorsed 130 out of 190 statements as appropriate actions. These included help for a bereaved adolescent being offered on an ongoing basis, with support to be provided flexibly to meet individual adolescent needs and to acknowledge the agency of the adolescent. Support after a loss by suicide should be tailored to address specific suicide-related issues. Parents of bereaved adolescents should also be offered support so that they are better equipped to help their bereaved adolescent.

CONCLUSIONS

This study identified consensus recommendations on how a helping professional might best help bereaved adolescents. It is hoped that these recommendations will guide helping professionals and enhance adolescent grief interventions.

An integrative systematic review of online resources and interventions for people bereaved by suicide

Suicide bereavement is frequent in the general population and it can have deleterious consequences on the mental health and social functioning of the bereaved individuals. However, those bereaved can face substantial barriers to receive support, and online resources may improve the accessibility of support. This systematic review aimed at examining the use and benefits of online resources dedicated to people bereaved by suicide and appraising the quality of the research in this field. Systematic review according to PRISMA guidelines, involving searches in Pubmed, Scopus and Web of Science, conducted in August 2020. The integrative systematic review involved extracting and merging qualitative and quantitative data. Quality assessment was conducted with the Mixed Methods Appraisal Tool (MMAT). The review included 12 studies, mostly of moderate quality. Online resources are predominantly used by middle-aged women, parents who lost their child by suicide, and recently bereaved individuals. Online resources offer a way for help-seeking around the clock for less educated, more disadvantaged and isolated people. People bereaved by suicide use online resources to seek and share support, share and find information, memorialize their loved one and for meaning-making. Negative effects of online resources are rare. The evidence on the use and benefits of online resources for people bereaved by suicide remains scarce but show encouraging results regarding their positive impact on the mental and psychosocial health of the users.

Suicidology Post Graduate Curriculum: Priority Topics and Delivery Mechanisms for Suicide Prevention Education

BACKGROUND

There has been limited attention to the development and delivery of tertiary suicide prevention curricula. The aim of this work was to describe the status of postgraduate suicide prevention education, with specific attention on examining the needs of the suicide prevention sector in Australia.

METHOD

An online survey was completed by 76 stakeholders in Australia. Current curriculum learning outcomes from Griffith University's postgraduate suicidology programs guided the development of the survey.

RESULTS

Four key learning domains were rated highest in importance by stakeholders. According to most stakeholders, skills-based qualifications were the most relevant type of qualification, and online modulized education was the most preferred delivery mode. Half of stakeholders supported suicide prevention professional development through a combination of financial support and study leave.

CONCLUSIONS

The survey provided invaluable feedback regarding the priorities of Australia's suicide prevention sector for content domains and delivery mechanisms for tertiary suicidology education. The findings showed the preferred type of organizational (employer) support that may be provided for employees to undertake such education. These findings will inform the future developments of Griffith University's suicidology programs and may motivate other universities to consider offering same or a similar type of education to support the suicide prevention sector toward saving lives.

"Finding a safe space": A qualitative study of what makes help helpful for adolescents bereaved by suicide

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.

Effectiveness of Psychosocial Interventions for Family Members and Other Informal Support Persons of Individuals Who Have Made a Suicide Attempt

Background: Individuals recovering from a suicide attempt may benefit from support provided by informal carers, that is, family members and other support persons, who may require support themselves. Aims: This systematic review aims to identify and synthesize available literature on the effectiveness of psychosocial interventions for this carer population. Method: A search of peer-reviewed literature in five databases was carried out. Studies using any design were eligible and results were synthesized using a narrative review. Results: Eight articles reporting on seven quantitative studies met the eligibility criteria. This included three studies on interventions designed specifically for informal carers and four studies on interventions designed for persons who have made a suicide attempt, and which involved their informal carers. Overall, informal carers were satisfied with support and psychosocial interventions they received. Interventions were related to some improvements in carers' mental health outcomes, lowered burden, and improved ability to provide care. There were mixed results regarding family functioning and quality of life. Limitations: No studies from lower- and middle-income countries were identified and the small number of heterogeneous studies precluded conducting a meta-analysis. Conclusion: Given the low number of studies and their overall poor quality, this review can only draw preliminary conclusions. More high-quality intervention studies are needed to formulate recommendations for effective psychosocial support for family members and other informal support persons after a suicide attempt.

Ethical concerns in suicide research: thematic analysis of the views of human research ethics committees in Australia

BACKGROUND

Suicide research aims to contribute to a better understanding of suicidal behaviour and its prevention. However, there are many ethical challenges in this research field, for example, regarding consent and potential risks to participants. While studies to-date have focused on the perspective of the researchers, this study aimed to investigate the views and experiences of members of Human Research Ethics Committees (HRECs) in dealing with suicide-related study applications.

METHODS

This qualitative study entailed a thematic analysis using an inductive approach. We conducted semi-structured interviews with a purposive sample (N = 15) of HREC Chairs or their delegates from Australian research-intensive universities. The interview guide included questions regarding the ethical concerns and challenges in suicide-related research raised by HREC members, how they dealt with those challenges and what advice they could give to researchers.

RESULTS

The analysis identified four main themes: (1) HREC members' experiences of reviewing suicide-related study applications, (2) HREC members' perceptions of suicide, suicide research, and study participants, (3) Complexity in HREC members' decision-making processes, and (4) HREC members' relationships with researchers.

CONCLUSIONS

Reliance on ethical guidelines and dialogue with researchers are crucial in the assessment of suicide-related study applications. Both researchers and HREC members may benefit from guidance and resources on how to conduct ethically sound suicide-related studies. Developing working relationships will be likely to help HRECs to facilitate high quality, ethical suicide-related research and researchers to conduct such research.

The Experiences of Grief and Personal Growth in University Students: A Qualitative Study

BACKGROUND

Experiencing the death of a close person, especially in emerging adults and students, can have profound effects on the bereaved individual's life. As most research in this field has focused on negative effects of a loss, little is known about potential positive effects experienced by bereaved university students. This study investigated the experience of grief and personal growth in a sample of students from The University of Melbourne, Australia.

METHODS

Semi-structured interviews via Zoom/telephone with bereaved students (n = 14), who were invited to reflect on their loss and any personal growth potentially experienced. Thematic analysis of the data was based on a deductive and inductive approach.

RESULTS

The analysis identified four themes: (i) sharing of grief as a coping mechanism, (ii) balance between grief reactions and moving forward in life, (iii) lessons learned and personal growth, and (iv) adopting values from the deceased person and continuing bonds.

CONCLUSIONS

Participants emphasized personal growth regarding self-perception and philosophical views on life. Following the loss, they preferred peer support, and used formal services only when they had a specific need. The findings indicate the importance of social support for bereaved students, and the complimentary role of peer and professional support. Hence, academic institutions should offer supportive services tailored to both students and professionals to help bereaved students.

International study of definitions of English-language terms for suicidal behaviours: a survey exploring preferred terminology

OBJECTIVES

Explore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs).

DESIGN

An online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency.

SETTING

International.

PARTICIPANTS

Respondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations.

OUTCOME MEASURES

Definitions of English-language terms for suicidal behaviours.

RESULTS

The recommended definition of 'suicide' describes a fatal act initiated and carried out by the actors themselves. The definition of 'suicide attempt' was restricted to non-fatal acts with intent to die, whereas definition of 'self-harm' more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of 'suicidal ideation', 'death wishes' and 'suicide plan'. 'Aborted suicide attempt' and 'interrupted suicide attempt' were not considered components of 'preparatory suicidal behaviour'. There were several differences between representatives from HICs and LMICs.

CONCLUSION

This international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.