Exploring the impact of suicide care experiences and post-intervention supports sought among community pharmacists: a cross-sectional survey

BACKGROUND

There is a need to appropriately train, support and remunerate pharmacists for their expanding roles in mental healthcare. Pharmacists often care for people experiencing mental health crises, including suicidal thoughts and behaviours, but little is known about pharmacists' suicide care experiences.

AIM

This cross-sectional study aimed to explore the impact of professional experiences with people at risk of suicide and support accessed, among community pharmacists.

METHOD

A survey exploring pharmacists' experiences with people at risk of suicide and post-intervention support-seeking was disseminated through Australian and Canadian professional associations, conferences and social media (June 2016-May 2017). Quantitative data were analysed using Chi-squared, Fisher's exact and independent t-tests, where appropriate. Qualitative data exploring the impact of these experiences were thematically analysed, and reasons for not seeking help post-intervention were identified.

RESULTS

Among 378 respondents, 84% had encountered patients at risk of suicide and 28% had lost patients to suicide. Some were negatively affected personally and/or professionally (11%), of which 88% did not seek professional support, mainly due to uncertainty about available services. Pharmacists were significantly more negatively affected if they had a personal mental health diagnosis (p = 0.017) and previous suicide care experiences (p = 0.001). Qualitative themes included: expanding knowledge and skills, role limitation and emotional impact and response.

CONCLUSION

A large proportion of pharmacists have interacted with suicidal patients and are impacted by these experiences, yet few seek help due to lack of awareness and access. There is a need to recognize pharmacists' roles in suicide care, and develop pharmacist-specific post-intervention support.

[Development of an online intervention on suicidality-providing knowledge and reducing suicide stigma]

Bei Suizidalität können die Angst, von anderen stigmatisiert zu werden, sowie Selbststigmatisierung und unzureichende Informationen dazu führen, dass Hilfsangebote weniger oder gar nicht in Anspruch genommen werden. E‑Mental-Health-Interventionen sind eine Möglichkeit, niederschwellig viele Betroffene über die Thematik zu informieren und auf persönliche Hilfsangebote vorzubereiten. Am Universitätsklinikum Hamburg-Eppendorf wurde eine komplexe Intervention entwickelt, gefördert im Rahmen des Förderschwerpunkts „Suizidprävention (A: Entstigmatisierung)“ des Bundesministeriums für Gesundheit. Entwicklung und Inhalte dieser Onlineintervention sollen im vorliegenden Beitrag beschrieben werden.

Nach einer repräsentativen Telefonbefragung der deutschen Allgemeinbevölkerung, mit der Wissenslücken und Stigmatisierungstendenzen zum Thema Suizid untersucht wurden, entstand auf Basis eines australischen Suizidpräventionsprojekts und in Zusammenarbeit mit Betroffenen und Angehörigen die Onlineintervention „8 Leben – Erfahrungsberichte und Wissenswertes zum Thema Suizid“. Darin wurden sowohl wissenschaftlich-klinische Fakten rund um das Thema Suizidalität als auch eine gesellschaftlich-kulturelle Perspektive beleuchtet sowie auf Selbsthilfemöglichkeiten und professionelle Hilfsangebote verwiesen. Es wurden Videoerfahrungsberichte von Betroffenen und Angehörigen gezeigt. Aktuell wird das Projekt ausgewertet. Eine Weiterführung ist geplant.

In der Intervention werden verschiedene Sichtweisen gezeigt und die Personen, die die Intervention in Anspruch nehmen, werden sowohl auf kognitiver als auch auf emotionaler Ebene angesprochen. Aufgrund der Prävalenz von Suizidalität und der dennoch bestehenden Tabuisierung des Themas scheinen seriöse, evidenzbasierte und niedrigschwellige Präventions- und Informationsangebote besonders relevant.

The Impact of Educative News Articles about Suicide Prevention: A Randomized Controlled Trial

Media stories featuring stories of personal experiences of coping with suicidal ideation have been shown to decrease suicide risk, but it is unclear whether more impersonal awareness materials have similar effects. This study aimed to test the impact of impersonal educative news articles featuring interviews with suicide prevention experts. Because the impact of news articles may be determined by the articles' pull quotes and headlines, we also aimed to compare the impact of two versions of the same suicide prevention news article. One version featured headlines and pull quotes highlighting the message that suicide is preventable, whereas the other version focused on the message that suicide is prevalent. In a web-based randomized controlled trial, n = 425 participants either read a news article featuring a prevention expert with one of the above versions of the same text or an article unrelated to suicide. Data on suicidal ideation, stigmatizing attitudes toward suicidal individuals, policy attitudes toward suicide prevention, help-seeking intentions, and assumptions on the prevalence of suicide-related behavior were measured with questionnaires. The assumed prevalence of suicide in the population was greater in both intervention groups than in the control group, but the articles did not have an impact on other outcomes, and there were no differences for variations in headlines and pull quotes. Impersonal suicide prevention articles appear safe to use and do not have an impact on suicide risk factors in general population samples.

Effects of suicide prevention videos developed by and targeting adolescents: a randomized controlled trial

Suicide prevention videos featuring young people's personal narratives of hope and recovery are increasingly used in suicide prevention, but research on their effects is scarce. A double-blind randomized controlled trial was conducted to test the effects of a suicide prevention video featuring an adolescent mastering his suicidal ideation by getting help on 14 to 19-year-olds. N = 299 adolescents were randomly allocated to watch the intervention video (n = 148) or a control video unrelated to mental health (n = 151). Questionnaire data were collected before (T₁) and immediately after exposure (T₂), and 4 weeks later (T₃). Data were analyzed with a repeated-measures ANCOVA. The primary outcome was suicidal ideation, assessed with the Reasons for Living Inventory for Adolescents. Secondary outcomes were help-seeking intentions, attitudes towards suicide, stigmatization of suicidality, and mood. There was an immediate beneficial effect of the intervention on suicidal ideation (T₂ mean change from baseline within intervention group M_Change = - 0.16 [95% CI - 0.20 to - 0.12], mean difference compared to control group M_Diff = - 0.09 [95% CI - 0.15 to - 0.03], η_p² = 0.03), which was not maintained at T₃. Participants reported significantly higher help-seeking intentions, which was maintained at 4-week follow-up. They also reported a sustained reduction of favorable attitudes to suicide. Effects on suicidal ideation were mediated by identification with the featured protagonist. Adolescents appear to benefit from suicide prevention narratives featuring personal stories from peers on coping with suicidal ideation and help-seeking.Trial registration DRKS00017405; 24/09/19; retrospectively registered.

Validity of the Personal Suicide Stigma Questionnaire in a Community Sample

Abstract. The Personal Suicide Stigma Questionnaire (PSSQ) is a new scale assessing the experience of stigma in those who have been suicidal. This study examined the construct validity of the scale using a sample of participants from the general community who reported being suicidal at some point in their lives ( N = 3,947). The Distress Questionnaire – 5 and the Suicidal Ideation Attributes Scale were used to assess the severity of distress and suicidality. Confirmatory factor analysis (CFA) showed a three-factor model (Rejection, Minimization, Self-Blame) with one general Personal Stigma factor influencing the three first-order factors, which best fit the data. Scalar invariance was reached for both age and gender. The same factor structure was maintained when the format of the scale was altered for a subsample to provide a “not applicable” option for each item. PSSQ total score remained a significant predictor of distress after suicidality and demographic variables were accounted for. The PSSQ and its subscales can be used for the assessment of personal suicide stigma.

The Youth Aware of Mental Health program in Australian Secondary Schools: 3- and 6-month outcomes

OBJECTIVE

The evidence base for suicide prevention programs in Australian schools is limited. The aim of this study was to examine the impact of a universal, mental health promotion and suicide prevention program-Youth Aware of Mental Health (YAM)-on suicidal ideation, mental health, and help-seeking in Australian secondary school students from baseline to post-intervention and 6-month follow up.

METHODS

Using a single-arm design, the YAM program was delivered to Year 9 students (13-16 years) in secondary schools located within four regions across New South Wales, Australia. A structured self-report questionnaire using validated scales was administered at each time point. Linear mixed-effects modelling was used to examine differences in suicidal ideation scores across time, while accounting for random effects of individual schools.

RESULTS

Suicidal ideation reduced significantly from baseline to post, and from baseline to follow-up (p < 0.001). Depression severity declined (p < 0.001) and help-seeking intentions increased (p < 0.001) at post-intervention and 6- months following the intervention period. No suicide deaths were reported for any study participants.

CONCLUSION

The current findings provide preliminary evidence that the YAM program is a promising preventive intervention for Australian schools, particularly for reducing suicidal ideation, depression and increasing help-seeking intentions in young people. The implementation of YAM in a large number of schools across New South Wales demonstrates the feasibility, and acceptability by schools, of implementing this program at scale.

TRIAL REGISTRATION

ANZCTR, ACTRN12619000338167. Registered 5 March 2019-Retrospectively registered, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376989&isReview=true .

Does self-esteem inflation mitigate mortality salience effects on suicide attitudes?

INTRODUCTION

Suicide stigma is a major barrier to prevention and intervention efforts. Using terror management theory as the guiding framework, the present study examined whether enhancing self-esteem would buffer against suicide stigma and lead to prosocial attitudes and behavior.

METHODS

Experimental methods were utilized in the present study. After being primed with death-related thoughts, participants were randomly assigned to one of two conditions: (1) positive feedback (experimental group) and (2) no feedback (control group). The dependent variables included (1) evaluations of a suicide decedent, (2) intentions to intervene against suicide, and (3) charitable donation behavior toward a suicide prevention organization.

RESULTS

The most consistent findings for the self-esteem boost hypothesis were for the interaction effects of death anxiety and self-esteem boost for the donation allocation task and intentions to intervene against suicide. For participants who were reminded of death, the self-esteem boost intervention mitigated the negative impact of death anxiety on donation behavior (i.e., an average difference of $16.37). Positive feedback for participants with reported low self-esteem also led to increased willingness to intervene against suicide.

CONCLUSION

These findings provide some promising potential for the self-esteem enhancement intervention to attenuate defensive reactions to suicide.

The stigmatization of suicide: A study of stories told by college students in China

This study unpacks the dimensions of suicide stigma through an analysis of the stories told by college students in China. The phronetic iterative approach was used to analyze the interview data of 30 college students. Findings showed that college students use the strategy of othering in creating a distinction between us and them. Those who attempt or die by suicide are labeled as irresponsible, fragile, impulsive, and attention-seeking. Suicides of ingroup members are usually described as controllable, while the suicides of outgroup members are often deemed uncontrollable. Finally, suicides lead to a status loss for individuals and their social groups.

Comparison of Stigmatization of Suicidal People by Medical Professionals with Stigmatization by the General Population

Stigmatization of suicide (SOS) affects help-seeking for suicidality and impedes successful treatment. This study aimed to identify different types of stigmatization and understand the causes and glorification of suicide by comparing three groups; within each of the following groups, the impact of age and gender was explored: (1) practicing medical professional in direct contact with suicidality (psychotherapists, psychiatrists, related medical professions (nurses, etc.)), (2) future medical professionals still in training, (3) and the general population with no professional contact with suicidality. German adults completed an online survey with a total of 742 participants. A MANCOVA was calculated with age and gender being controlled as covariates, due to different distribution. Practicing professionals showed significantly higher levels of SOS than the other groups, while the future professionals showed no differences in SOS from the general population. The understanding of suicide causes was similar across all groups. Men showed higher levels of SOS than women, while women scored higher at understanding of causes and glorification of suicide. Within the individual groups, female professionals in the age group "36-65 years" stigmatized suicide most, while showing the least glorification. The results suggest that tendencies towards SOS are promoted by practical experience with suicidality. Therefore, special training is recommended to reduce SOS.

Effects of Exposure to Multiple, Graphic Suicide News Articles on Explicit and Implicit Measures of Suicide Risk

Research has examined suicide-related behaviors following exposure to suicide news articles, yet only a handful of studies utilized experimental designs. We aimed to address the limitations of these prior experimental studies by utilizing more realistic suicide articles and more empirically sound measures. 420 participants were randomly assigned to read a series of either suicide-related or neutral news articles, then complete a battery of questionnaires and the Death/Suicide Implicit Association Task. Overall, no significant differences between groups were observed, nor did we observe any moderation effect of individual vulnerabilities (e.g., lifetime suicidal ideation/behavior). We did not observe any immediate effects of exposure to suicide news articles. Further research examining potential mechanisms for imitative effects remains critically needed.

Suicide literacy, suicide stigma, and psychological help seeking attitudes among Arab youth

To date, very little is known about the current situation of suicide and its effects on psychological help-seeking attitudes in Arab countries. Therefore, this study aimed to assess the levels of suicide literacy and suicide stigma and their relationships with attitudes towards seeking psychological help among a sample of Arab youth in Jordan. A descriptive, correlational, cross-sectional study was conducted using an anonymous online self-report survey to collect data. This study included a total of 707 Arab youth aged 16-24 years (mean = 18.60, SD = 1.95). Most of the participants were male (n = 398, 56.3%). The participants were found to have very low suicide literacy levels, relatively high suicide stigma levels, and negative attitudes towards seeking psychological help. Family members, relatives, and friends were the most frequently reported sources of psychological help, while mental healthcare professionals were the least frequently reported sources. A significant negative correlation was found between attitudes towards seeking psychological help and both stigmatization and glorification subscales of suicide stigma. While a significant positive correlation was found between attitudes towards seeking psychological help and suicide literacy. The predictors of attitudes towards seeking psychological help were gender, suicide literacy, and glorification of suicide stigma among Arab youth. The results of this study confirm the presence of an urgent need for designing and implementing educational programs and awareness campaigns on suicide and mental health among youth in schools and universities. Such interventions may increase knowledge, decrease stigma, change psychological help-seeking attitudes, and hence improve the use of mental health services and may prevent suicide among this age group.

The Perceived Stigma Reduction Expressed by Young Adults in Response to Suicide Prevention Videos

Evidence indicates that stigma impedes an individual’s chance of seeking professional help for a mental health crisis. Commonly reported aggregate-level results for stigma-reduction efforts obfuscate how much stigma reduction is needed to incur a practically meaningful change within an individual, defined here as an attitudinal shift and openness towards seeking mental health for oneself and/or support for others. When basing conclusions and recommendations about stigma-reducing interventions on aggregate scales, it is unclear how much stigma reduction is needed to incur meaningful change within an individual. We explored the impact of reductions in stigma of help-seeking scores in response to an online suicide prevention video among young adults in the United States, using online surveys to collect qualitative and quantitative data. We compared mean changes in the stigma scores from pre- to post-test (video exposure) of 371 young U.S. adults using standard t-tests and individual level analysis. A separate thematic analysis of free-text responses was also conducted from a smaller, randomly-selected subgroup, capturing individuals’ attitudes towards help-seeking for mental health problems. Great attention was given to participants to ensure that they were in a campus setting where counseling services were available. Four main themes emerged: (1) small changes in stigma scores were associated with individual reports of meaningful reductions in their attitudes towards professional counseling; (2) increased empathy towards victims of suicide and other mental health problems sometimes indicated increased empathy for victims of suicide and decreased openness in professional help; (3) empathy towards victims sometimes took the form of increased scores and grief or sadness, possibly thwarting the potential for help-seeking; and (4) self-reports of decreased stigma were not always associated with increased openness towards help-seeking. Results also indicated that small stigma score charges, not meeting statistical significance, were often associated with increased openness towards seeking help. These findings, discovered using mixed-methods, contribute to the body of literature regarding stigma towards suicide and help-seeking by demonstrating deficits in the aggregate-only analysis of stigma-reducing interventions specifically aimed at suicide prevention. Such individuation in stigma experiences indicates that public education on how to reduce the stigma of help-seeking for suicide prevention needs to consider individual-level analyses for improving target populations. Recommendations for future research include additional studies prior to releasing suicide prevention videos to public forums where they may be seen by individuals without access to help.

Depression and Anxiety Predict Healthcare Workers' Understanding of and Willingness to Help Suicide Attempt Patients

We examined whether burnout, depression, anxiety, stress, lifetime suicidal ideation, self-efficacy in preventing suicide and demographic factors predicted the understanding of and willingness to help suicidal patients among hospital healthcare workers. A total of 368 healthcare workers from the major surgical and medical departments in a general hospital setting were recruited. Participants responded to the Depression Anxiety and Stress Scale-21, Self-efficacy in Suicide Prevention, and Understanding Suicide Attempt Patient Scale. Those from the psychiatric department, with higher suicide prevention self-efficacy, and lower personal accomplishment indicated more understanding and helpful attitudes; doctors, depressed and anxious healthcare workers reported less understanding and helpful attitudes. Suicide prevention efforts must be conducted in tandem with equipping and supporting the healthcare workers who manage suicidal patients.

Measuring Attitudes toward Suicide Prevention among Occupational Staff Frequently Exposed to Suicidal Individuals: Psychometric Evaluation and Validation

As the attitudes of healthcare staff are thought to influence the quality and effectiveness of interventions targeting patients’ suicide risk, attitudes are often used as an outcome in the evaluation of suicide-preventive training. Due to various problems related to the validity and reliability of commonly used scales, there is a lack of overall agreement on how to measure these attitudes. Confirmatory factor analysis (CFA) was used to cross-validate previously used models and to investigate new models to measure professionals’ attitudes toward work with suicidal individuals and to test the longitudinal stability of the models by analyzing new sets of data. The population in the first study consisted of a heterogenous group of 1350 professionals who managed suicidal individuals relatively frequently. The second study included 640 professionals. The results of the cross-validation of previous models were described and a new questionnaire measuring attitudes toward suicide prevention, suicidal individuals, and organizational-facilitated self-efficacy (OSAQ-12) was presented. The three presented models retained a good fit and were stable over time. Valid and reliable measurement models that measure aspects of attitudes toward suicide are a prerequisite for conducting both cross-sectional and intervention studies.

Perceived Suicide Stigma and Associated Factors in Chinese College Students: Translation and Validation of the Stigma of Suicide Attempt Scale and the Stigma of Suicide and Suicide Survivors Scale

This study aims to translate and validate two perceived suicide stigma scales, including the Stigma of Suicide Attempt Scale (STOSA) and the Stigma of Suicide and Suicide Survivor Scale (STOSASS) into Chinese language, examining the factor structure, and assessing the correlation between suicide stigma and a series of variables. After translating and back translating the STOSA and STOSASS, an online survey was administrated to 412 college students in China. These two scales were tested for their dimensionality in a series of confirmatory factor analyses. A series of regression analyses were conducted to examine the factors that are associated with perceived and public suicide stigma, including demographics, psychological distress, suicidality, suicide exposure, and perceived entitativity of suicide ideators, decedents, and survivors. The results showed that the two translated scales, STOSA and STOSASS, were reliable (Cronbach’s α = 0.79~0.83) and valid in Chinese contexts and it can be treated as unidimensional scales. Suicidality, exposure to suicide, and perceived entitativity of suicide-related persons were significantly associated with higher endorsement of public suicide stigma (SOSS Stigma, p < 0.03), but not perceived stigma (STOSA, STOSASS). Higher levels of psychological distress were associated with both higher perceived and public suicide stigma (p < 0.05).

Clinicians' Perspectives on Self-Harm in Pakistan: A Qualitative Study

Background: Suicide is a serious public health problem, ranked amongst the leading causes of death worldwide. There are no official data on self-harm and suicide in Pakistan; both are illegal acts, and are socially and religiously condemned. This study explored the views of clinicians, including general practitioners (GPs) and hospital physicians (HPs) on self-harm, about their management of people who self-harm and what interventions might be appropriate in Pakistan. Methods: This qualitative study, generating data using semi-structured interviews, was nested within a Randomized Controlled Trial (RCT) of a psychosocial intervention for people following self-harm. Clinicians (n = 18) with experience of treating people who self-harm were recruited from public hospitals and general practices. Results: Face-to-face interviews were conducted in Urdu and digitally recorded with consent, transcribed and translated into English. Transcripts were checked for cultural and interpretive interpretations by the research team, then analyzed thematically using the principles of constant comparison. The following themes will be presented: encountering people with self-harming behaviors; challenges encountered in managing people who self-harm; barriers to accessing care, and what ideal care might look like. Participants identified their lack of training and expertise in the management of people with self-harm behavior. Conclusions: This is the first study to explore clinicians' perspectives on self-harm in Pakistan. The study highlighted the need for training for doctors in the identification and management of mental health problems, including the management of people who self-harm.

Emerging Adults' Attitudes and Beliefs About Suicide and Technology/Social Media

Suicide in emerging adults (18-29 years) is increasing in the United States, especially amidst coronavirus disease 2019. How the use of technology/social media affects suicidal behaviors is unclear. The purpose of this study was to examine attitudes and beliefs of emerging adults about suicide and identify whether relationships exist with technology/social media use. A total of 297 participants completed an online survey examining attitudes about suicide and technology use. Results indicate a normalization of suicide. Significant relationships were found with technology/social media, including a positive relationship between YouTube and glorification/normalization of suicide. Recommendations for primary and secondary suicide prevention are made for nurse practitioners in various settings.

Factor Structure and Measurement Invariance of the Stigma of Suicide Scale–Short Form Among Adolescents and Early Adults in Hong Kong

Suicide is a global public health concern. The Stigma of Suicide Scale–Short Form (SOSS-SF) is a brief measure on the stigma toward suicide. This study aimed to examine the psychometric properties of the SOSS-SF in a sample of 1,946 adolescents and early adults ( M age = 23.3, 69% females) in Hong Kong. The participants completed the SOSS-SF, measures on suicidal ideation and perceived distress, and binary items on lifetime risk behaviors online. Exploratory structural equation modeling evaluated the factor structure and reliability of the SOSS-SF in split samples and its measurement invariance, convergent validity, and discriminant validity in the overall sample. Contrary to a poor fit for the three-factor structure in the original 16-item SOSS-SF, the four-factor model showed a good fit in the revised 12-item version in both subsamples. The four factors (Glorification, Isolation, Disgrace, and Selfishness) loaded significantly on three items each (λ = .52-.93) and had adequate reliability (ω = .78-.88). The SOSS-SF displayed scalar invariance across age group, gender, and suicidal ideation and significant associations with validating variables. These results demonstrate a valid and reliable four-factor structure for the SOSS-SF and support its use for assessment of multifaceted stigma toward suicide.

Suicide and Self-inflicted Injury in Diabetes: A Balancing Act

Glycemic control in type 1 diabetes mellitus (T1DM) remains a challenge for many, despite the availability of modern diabetes technology. While technologies have proven glycemic benefits and may reduce excess mortality in some populations, both mortality and complication rates remain significantly higher in T1DM than the general population. Diabetes technology can reduce some burdens of diabetes self-management, however, it may also increase anxiety, stress, and diabetes-related distress. Additional workload associated with diabetes technologies and the dominant focus on metabolic control may be at the expense of quality-of-life. Diabetes is associated with significantly increased risk of suicidal ideation, self-harm, and suicide. The risk increases for those with diabetes and comorbid mood disorder. For example, the prevalence of depression is significantly higher in people with diabetes than the general population, and thus, people with diabetes are at even higher risk of suicide. The Center for Disease Control and Prevention reported a 24% rise in US national suicide rates between 1999 and 2014, the highest in 30 years. In the United Kingdom, 6000 suicides occur annually. Rates of preventable self-injury mortality stand at 29.1 per 100 000 population. Individuals with diabetes have an increased risk of suicide, being three to four times more likely to attempt suicide than the general population. Furthermore, adolescents aged 15 to 19 are most likely to present at emergency departments for self-inflicted injuries (9.6 per 1000 visits), with accidents, alcohol-related injuries, and self-harm being the strongest risk factors for suicide, the second leading cause of death among 10 to 24 year olds. While we have developed tools to improve glycemic control, we must be cognizant that the psychological burden of chronic disease is a significant problem for this vulnerable population. It is crucial to determine the psychosocial and behavioral predictors to uptake and continued use of technology in order to aid the identification of those individuals most likely to realize benefits of any intervention as well as those individuals who may require more support to succeed with technology.

Knowledge of Suicide Risk Factors, But Not Suicide Ideation Severity, Is Greater Among College Students Who Viewed 13 Reasons Why

Objective: To test associations between viewing 13 Reasons Why, Season 1 and past week suicide ideation severity, behavior risk, stigma, and knowledge in college students. To explore whether personal exposure to suicide and depressive symptom severity moderated these associations. Participants: Eight-hundred and eighteen college students, 64% (n = 522) of whom watched 13 Reasons Why. Methods: Students completed surveys online. Multivariate negative binomial regressions were used to test associations between watching 13 Reasons Why and suicide-related variables, and interaction terms. Results: Suicide ideation severity and suicide behavior risk were not significantly associated with viewing 13 Reasons Why; however, there was limited statistical power to detect associations. The association between watching 13 Reasons Why and greater suicide knowledge was stronger among those who did not have personal exposure to suicide. Conclusions: 13 Reasons Why may be a platform for psychoeducation on suicide, particularly among those who do not have personal exposure.

Training Student Pharmacists in Suicide Awareness and Prevention

Objective. To determine whether students gained knowledge, confidence, and skills in identifying and preventing suicide in patients, peers, friends, and family after receiving training in suicide prevention. Methods. Student pharmacists participated in a 3.5-hour suicide prevention training program. A pre- and post- intervention assessment and pre- and post-intervention survey were administered before and after completion of the training program. Questions were designed to assess knowledge of, comfort with, and confidence in assessing and intervening with individuals at risk of suicide. A standardized patient prescription counseling session was conducted two weeks after the training session. Videos of the counseling sessions were reviewed to determine whether student pharmacists assessed the patient for suicide risk. Additionally, a post-counseling reflection was completed asking students to reflect on incorporation of the suicide prevention training into their prescription counseling session. Results. One-hundred seventy-one student pharmacists participated in the training. Knowledge increased across all areas as evidenced by improved scores on the post-intervention knowledge assessment. Students' comfort level with asking about suicidal ideation and their confidence with intervening significantly increased from the pre- to post-intervention survey. After the training, 40% stated they knew someone who may need help and 21% said they had decided to seek help for themselves. Conclusion. The training program increased student pharmacists' knowledge of and confidence in assessing and counseling individuals considering suicide. Encouraging student pharmacists to participate in prevention training may aid future providers in preventing death by suicide.

[The Stigma of Suicide Scale: Psychometric Validation of the German Short Version (SOSS-SF-D)]

OBJECTIVE

The Australian Stigma of Suicide Scale (SOSS-SF) was translated and tested for applicability and psychometric properties in Germany. Further, it was investigated whether the observed factors from the Australian original could be replicated in a German sample.

METHODS

Based on a nation-wide, representative telephone survey (N = 2,002), the 16 items of the SOSS-SF-D were examined with a principal component analysis (varimax rotation). Mean values, standard deviations and medians as well as the z-standardized values for skewness and kurtosis were determined.

RESULTS

The principal component analysis revealed 3 subscales (stigma, normalization/glorification, depression/isolation), just as in the Australian sample. Internal consistency of the subscales was acceptable (Cronbachs α: 0.64-0.78).

CONCLUSION

The SOSS-SF-D is a valid and short instrument for measuring the multidimensionality of attitudes towards suicidal persons.

A Theory-Based Longitudinal Investigation Examining Predictors of Self-Harm in Adolescents With and Without Bereavement Experiences

BACKGROUND

Research has demonstrated that exposure to suicide can lead to increased vulnerability for self-harm or suicide. As a result, ideation-to-action models of suicide (e.g., the Integrated Motivational-Volitional Model of Suicide; IMV) recognise exposure as a significant risk factor which may be implicated in the translation of thoughts into actions. However, few studies have tested this theoretical link explicitly within an adolescent population, and examined how it compares to other types of bereavements.

METHODS

A 6-month prospective questionnaire study was conducted with 185 Scottish adolescents aged 11-17 (113 adolescents also completed the questionnaire at follow-up). The questionnaire included measures on experiences with bereavement and lifetime engagement in self-harm, as well as measures of defeat, entrapment, social support, coping, and other psychological variables.

RESULTS

At baseline, 12% of young people reported exposure to a suicide death, and 61% to a non-suicide death. In addition, 21% of pupils reported ever engaging in self-harm, while 23% had experienced self-harm ideation without engaging in it. Cross-sectional multivariate logistic regressions showed that family social support, glorifying/normalising beliefs about suicide, and family self-harm were significantly associated with self-harm group membership (control, ideation, or enactment groups). At follow-up, 10% of pupils reported exposure to a suicide death and 16% to a non-suicide death for the first time. A total of 26% of the sample reported self-harm at T2 (11% of participants for the first time), and 24% reported self-harm ideation without engaging in it. Multivariate analyses found that self-harm ideation and family self-harm at baseline were the only variables to predict self-harm group membership prospectively, in the expected directions. Bereavement experiences, whether by suicide or non-suicide, did not predict self-harm group status at baseline nor at follow-up.

CONCLUSIONS

This study provides support for the validity of a theoretical model of suicide, even though predictive ability over the 6-months period was limited. Although difficulties with recruitment may have limited the statistical power, this study provides insight into the prevalence and experiences of suicide bereavement among adolescents and the factors related to the onset and maintenance of self-harm.

Anticipated Suicide Stigma, Secrecy, and Suicidality among Suicide Attempt Survivors

OBJECTIVE

Suicidal behavior is stigmatized, and suicide attempt survivors often keep their experiences secret. Although secrecy can protect from discrimination, research from related fields suggests that both the experience of stigma and secrecy can contribute to suicidality. Although suicide attempt survivors are at high risk for reattempt, research investigating the link between suicide stigma and suicidality among this group is rare.

METHOD

A community sample of 159 suicide attempt survivors participated in an online survey in the US. We used multiple linear regression models to test the association between anticipated suicide stigma and current suicidality, as well as a path model to test the mediating effect of secrecy.

RESULTS

After controlling for age, sex, number of lifetime suicide attempts, and time since the most recent suicide attempt, anticipated suicide stigma was significantly associated with increased suicidality. In a controlled path model, this link was partially mediated by increased secrecy.

CONCLUSION

These results provide initial support that anticipated suicide stigma, and secrecy can contribute to suicidality among suicide attempt survivors. Therefore, programs to support suicide attempt survivors in coping with suicide stigma and secrecy, as well as interventions to reduce harmful aspects of public suicide stigma, could contribute to suicide prevention.

The ripple effect: a digital intervention to reduce suicide stigma among farming men

BACKGROUND

Compared with the general population, Australian farmers-particularly men-have been identified as at greater risk of suicide. A complex range of factors are thought to contribute to this risk, including the experience of Stigma. stigma also impacts those who have attempted suicide, their carers, and those bereaved by suicide-manifesting as shame, guilt, social isolation, concealment of death, reduced help seeking and ongoing risk of suicide. This paper evaluates the effectiveness of an intervention, tailored for the farming context, designed to reduce stigma among farming men with a lived experience of suicide.

METHODS

The digital intervention used an adult learning model providing opportunity to share insights, reflect, learn and apply new knowledge among people with shared farming interests, suicide experience and cultural context. A range of content-tailored to the gender, farming type and suicide experience of participants-included video stories, postcard messages, education and personal goal setting. Pre- and post- assessment of suicide stigma and literacy was complemented by qualitative data collection during the intervention and participant feedback surveys.

RESULTS

The intervention was successful in reaching members of the target group from across Australia's rural communities-with diverse geographic locations and farming industries represented. One hundred and sixty-nine participants from the target group (farming males aged 30-64 years) were recruited. While the Stigma of Suicide Scale failed to identify a reduction in self- or perceived-stigma, qualitative data and participant feedback identified behavioural indicators of stigma reduction. Four subthemes-'growth', 'new realisations', 'hope' and 'encouragement'-highlighted attitudinal and behaviour change indicative of reduced stigma associated with mental health and suicide. Participants' baseline suicide literacy (Literacy of Suicide Scale) was high when compared with previous community samples and total literacy scores did not demonstrate significant improvement over time, although literacy about the link between suicide and alcoholism did significantly improve.

CONCLUSIONS

These results highlight opportunities in groups with high suicide literacy for targeted stigma reduction and suicide prevention efforts for both the target group and other populations within Australia and internationally. Results also highlight the need to reassess how stigma change is understood and evaluated across a wider range of population groups.

TRIAL REGISTRATION

This research project was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12616000289415) on 7th March, 2016.

Psychometric properties of two Arabic Suicide Scales: stigma and literacy

Suicide is one of the leading causes of death. Suicide stigma and literacy may affect the rate of suicide and help-seeking behaviors. This study examined the psychometric properties of the Arabic version of the Stigma of Suicide Scale-short form (SOSS-SF) and Literacy of Suicide Scale (LOSS). The sample included 160 Jordanian university students. Reliability analysis showed acceptable Cronbach's alpha levels of the three SOSS-SF subscales (stigmatization, isolation, and glorification subscales). Factor analysis supported the construct validity of the SOSS-SF by showing three factor structure similar to the three original subscales. LOSS scores showed low literacy level about suicide with a passing rate of 55% and a mean score of 5.63 out 12. Students had more difficulty in answering questions related to signs/symptoms and risk factors of suicide. This study will enable Arabic clinicians to use these tools which assess important aspects about suicide.

Survey of Australian and Canadian Community Pharmacists' Experiences With Patients at Risk of Suicide

OBJECTIVE

The study's objective was to examine Canadian and Australian community pharmacists' experiences with people at risk of suicide.

METHODS

A survey was developed and administered online. Countries were compared by Fisher's exact and t tests. Multivariable logistic-regression analysis was used to identify variables associated with preparedness to help someone in a suicidal crisis.

RESULTS

The survey was completed by 235 Canadian and 161 Australian pharmacists. Most (85%) interacted with someone at risk of suicide at least once, and 66% experienced voluntary patient disclosure of suicidal thoughts. More Australians than Canadians had mental health crisis training (p<0.001). Preparedness to help in a suicidal crisis was negatively associated with being Canadian, having a patient who died by suicide, lacking training and confidence, and permissive attitudes toward suicide.

CONCLUSIONS

Several perceived barriers impede pharmacists' abilities to help patients who voluntarily disclose suicidal thoughts. Gatekeeper and related suicide prevention strategy training for community pharmacists is warranted.

What is good mental health? A scoping review

Promotion of good mental health in young people with and without mental disorders has received little empirical research attention and interventions for improving mental health in young people are not well established. This situation could be explained among other reasons due to the difficulties to define and operationalise what good mental health is. The current manuscript, produced by the European College of Neuropsychopharmacology Thematic Working Group on the Prevention of Mental Disorders and Mental Health Promotion (ECNP TWG PMD-MHP), presents a critical review of the available operationalizations for good mental health. A pragmatic conceptual operationalisation of good mental health is a much-needed step towards more standardised research in this field. Good mental health can be defined as a state of well-being that allows individuals to cope with the normal stresses of life and function productively. Universal and selective interventions are suitable to promote mental health. Core domains that define good mental health encompass: (i) mental health literacy, (ii) attitude towards mental disorders, (iii) self-perceptions and values, (iv) cognitive skills, (v) academic/ occupational performance, (vi) emotions, (vii) behaviours, (viii) self-management strategies, (ix) social skills, (x) family and significant relationships (xi) physical health, (xii) sexual health, (xiii) meaning of life, (xiv) and quality of life. These domains should be widely traceable in the literature and can be used to conduct further empirical research in the field of good mental health. Such data can lead to more robust evidence to identify and establish the pathways to follow in order to improve mental health.

Self-help interventions to reduce self-stigma in people with mental health problems: A systematic literature review

People with mental health problems often experience self-stigma, whereby they internalise stereotypic or stigmatising views held by others. Self-stigma is known to have negative effects on self-esteem and self-efficacy and a continuing impact on psychological wellbeing. Self-help interventions designed to reduce self-stigma may have an important contribution to make. This review aimed to provide an overview and critical appraisal of the literature on self-help interventions that target self-stigma related to mental health problems. A systematic review of five electronic databases (PsycINFO, MEDLINE, CINAHL Plus, Scopus and EMBASE) was carried out to identify articles published between January 2007 and July 2019. Eight articles that reported on self-help interventions for self-stigma were identified and evaluated using a combination of quality appraisal and narrative synthesis.

The Self-Stigma of Suicide Attempt Survivors

Although suicide attempt survivors report feelings of shame and stigmatization, no published scale measures self-stigma experienced by attempt survivors. This article describes the creation and validation the Self-Stigma of Suicide Attempt Scale (SSSAS). In this study, the SSSAS was validated in an online sample (n = 292) of suicide attempt survivors. Results supported the progressive model of self-stigma, wherein a substantial proportion of suicide attempt survivors were aware of stigma, but fewer applied that stigma to themselves or felt harmed by it. Reliabilities of SSSAS subscales were high. Harm subscale scores were correlated with depression, self-esteem, recovery, empowerment, and stigma stress in the expected directions. Future research can seek to further validate the scale and explore relationship between self-stigma and other constructs.

The Predictive Role of Positive Mental Health for Attitudes Towards Suicide and Suicide Prevention: Is the Well-Being of Students of the Helping Professions a Worthwhile Goal for Suicide Prevention?

This study evaluates the potential value of eudaimonic well-being in assessing pro-preventive orientation towards suicide and recognizing suicide as a solution. The aim was to integrate positive and negative conceptualizations of mental health for predicting attitudes towards suicide, and towards suicide prevention, among students of the helping professions. The study participants (166 women and 73 men, mean age 22.84 ± 5.15) answered a set of questionnaires, including a Questionnaire on Attitudes Towards Suicide, Goldberg Health Questionnaire (GHQ-28), Psychological Well-Being Scale (PWB-42) and Centrality of Religiosity Scale. Multiple regression analysis showed that environmental mastery, purpose in life and positive relationships, controlled for religiousness and psychological problems related to general mental health, predicted the variability of attitudes towards suicide and pro-preventive orientation. Sociodemographic variables were not related to attitudes towards suicide. Our findings suggest that positive mental health, represented jointly by low mental health problems and eudaimonic components of happiness, plays a role in predicting pro-preventive attitudes. Therefore, improving positive mental health among students in the helping professions, these being the future gatekeepers, could be considered an auxiliary strategy for suicide prevention.

The Effect of Sudden Death Bereavement on the Risk for Suicide

Background: Bereavement after a sudden death is associated with psychiatric sequelae including suicidal ideation and behavior. However, there is still uncertainty about whether bereavement due to suicide increases the risk for suicidal behavior more than bereavement due to other causes of death does. Aims: This study aimed to evaluate suicidal risk among sudden death-bereaved participants and to identify risk factors for suicidality that may be over-represented in those who are suicide-bereaved. Method: In total, 180 adult participants, half of whom had experienced the sudden death of a first-degree relative within the previous 5 years, completed self-report questionnaires assessing suicidal risk, symptoms of depression, somatization, posttraumatic stress disorder (PTSD), complicated grief, perceived social support, and demographic information. Results: Sudden death bereavement was associated with increased suicide risk even after adjusting for psychiatric symptomatology. Within the bereaved groups, the highest risk for suicide was among those bereaved by suicide, with additional contributions from depressive symptomatology, PTSD, somatization, lower perceived social support, and secular religious orientation. Limitations: The study was cross-sectional and bereaved participants had lost their loved one an average of 5 years before the assessment. Conclusion: These results are consistent with the conclusion that suicide bereavement is a risk factor for suicidal behavior.

Short- and Long-Term Impact of an Undergraduate Suicidology Course

OBJECTIVE

Suicide prevention models emphasize the importance of education as a foundational element for success. Yet, courses on suicidology are rare and those that do exist focus on clinical intervention skills at the graduate level, missing a critical population of undergraduate students. The current study evaluated the short and long-term impact of a semester long liberal education undergraduate course in suicidology.

METHOD

Students enrolled in either the experimental (Understanding Suicide) or control course completed pre- post- and 4-month follow-up surveys assessing objective knowledge about suicide, suicide stigma, attitudes towards suicidal persons, and suicide prevention advocacy.

RESULTS

Mixed repeated measures ANCOVAs indicated significant interactions between course enrollment over time for all the outcome variables. Students in the suicidology course showed significant pre- to post- increases in knowledge and suicide prevention advocacy, alongside reductions in suicide stigma and negative attitudes compared to students in the control course, who showed no significant pre-/post changes. All effects were maintained over time.

CONCLUSION

Providing general education undergraduate courses in suicidology may be an important avenue for building a motivated and informed public that can sustain suicide prevention efforts in their communities.

Psychologists' Willingness to Provide Services to Individuals at Risk of Suicide

OBJECTIVE

This study examined psychologists' willingness to accept a new client into their private practice as a function of the client's clinical presentation (with or without overt suicidality). Psychologists' openness to working with a client at risk of suicide was evaluated in the context of potential barriers to treatment provision, such as practitioners' endorsement of stigmatizing attitudes, concerns over liability and inadequate training, and limited access to community resources.

METHOD

Eighty-six licensed psychologists practicing within the United States were surveyed via e-mail and randomly assigned to one of two conditions, consisting of exposure to a vignette describing either a client reporting current suicidal ideation and a history of attempts or a client without explicitly elevated suicide risk. All participants were asked to complete a questionnaire assessing their likelihood of accepting the hypothetical client into their practice and examining possible explanations for disinclination to provide treatment.

RESULTS

Psychologists were less willing to work with a client experiencing suicidality than an individual without elevated suicide risk. Those indicating a reluctance to provide services reported greater concerns over the adequacy of their suicide-related skills and training and fewer resources in the community.

CONCLUSIONS

Recommendations for improving the responsiveness of private practitioners are provided, with an emphasis on enhancing clinical training and increasing the availability and accessibility of mental health resources.

Facets of clinical stigma after attempted suicide in Mumbai, India

Community stigma studies may neglect clinically relevant experience and views of stigma that are important features of mental health problems. After attempting suicide, patients in a hospital emergency ward in Mumbai, India, were assessed for stigma referring to underlying prior problems motivating their deliberate self-harm (DSH) event, the DSH event itself and serious mental illness generally based on both anticipated community views and distinctive personal views. In this cultural epidemiological study of 196 patients, assessment items and four corresponding indexes were analysed and compared on a four-point scale, 0 to 3, for prominence of indicated stigma. Narratives from patients with high, low and discordant levels of stigma for prior problems and DSH events were analysed and compared. Disclosure, critical opinions of others and problems to marry were greater concerns for DSH events than prior problems. Problem drinking, unemployment, and sexual or financial victimization were common features of prior problems. Impulsivity of the DSH event and externalizing blame were features of lower levels of stigma. Ideas about most people's views of serious mental illness were regarded as more stigmatizing than patients' prior problems and DSH event; patients' personal views of serious mental illness were least stigmatizing. Findings suggest linking suicidality and stigmatized mental illness may discourage help seeking. Suicide prevention strategies should therefore emphasize available help needed for severe stress instead of equating suicidality and mental illness. Findings also indicate the relevance of assessing clinical stigma in a cultural formulation and the value of integrated qualitative and quantitative stigma research methods.

Suicidal ideation disclosure: Patterns, correlates and outcome

This study aimed to identify how frequently suicidal individuals disclosed their ideation, assess which sources were perceived to be most helpful and identify correlates of disclosure and source helpfulness. A cross-sectional survey was conducted with 1,616 Australian adults reporting suicidal ideation in the past 12-months. Participants were recruited from social media and reported on their disclosure of suicidal thoughts to formal and informal sources. 39% of participants did not disclose to anyone, while 47% disclosed to an informal source and 42% to a health professional. The responses of psychologists and counsellors were perceived to be the most helpful, while parents and hospital-based health professionals were perceived to be the least helpful. Severity of suicidal thoughts, younger age, and a suicide attempt in the past 12-months were associated with greater likelihood of disclosure, while participants who were younger, linguistically diverse, had greater suicidal ideation or personal stigma were less likely to perceive the response of a GP to be helpful. This study demonstrates that non-disclosure of suicidal thoughts is frequent and that the response received to a disclosure may not always be perceived to be helpful. Further research is needed to identify how best to support individuals who disclose suicide.

Suicide Stigma and Suicide Literacy in a Clinical Sample

OBJECTIVE

The aims of this study were to (1) investigate levels and correlates of suicide stigma and suicide literacy in a sample of individuals attending a tertiary depression clinic in Australia (N = 287), with comparison to a community-based Australian sample (N = 1,410), and (2) validate measures of suicide stigma and literacy in a clinical sample.

METHOD

Australian adults (N = 287) aged 18-78 years referred by their general practitioners for assessment at a psychiatric clinic for patients with difficult-to-treat mood disorders were recruited to complete a survey, including measures of suicide literacy, suicide stigma, mental health symptoms, and demographics.

RESULTS

Compared to the Australian community sample, participants in the clinical sample reported lower suicide literacy, lower suicide stigma, greater glorification of suicide, and greater attribution of suicide to isolation. Suicide ideation was associated with greater glorification of suicide. Females had higher suicide literacy and lower suicide stigma than males. The psychometric properties of the suicide stigma measure appeared to be robust and consistent with previous evaluations.

CONCLUSION

Given the low levels of suicide literacy in this clinical sample, suicide prevention initiatives designed for community settings may also be important in clinical settings.

Is Suicide Beautiful?

Background: The sociocultural context shapes attitudes toward suicide. Japanese literary works such as the Hagakure and the Bunraku Sonezaki-Shinju depict suicide as beautiful and honorable. Although suicide acceptance is likely to affect suicide rates and prevention efforts in Japan, studies in this area are limited. Aims: This study aimed to explore suicide acceptance and related factors among Japanese participants. Method: Using an Internet research company, questionnaires were distributed that measured acceptance of suicide, suicide stigma, mental health, an opinion on suicide prevention efforts, and demographic variables. Data from 2,051 participants were analyzed using t tests, analysis of variance (ANOVA), and hierarchical regression analysis. Results: We found a two-factor model (comprising beautification and justification factors) for the suicide acceptance scale and confirmed the scale's validity and reliability. The results showed significant differences in suicide acceptance by gender, age, educational level, employment status, and bereavement experience. A hierarchical regression analysis model revealed that suicide beautification was negatively related to positive opinion on suicide prevention efforts. Limitations: This study only focused on Japanese participants; therefore, further studies and cross-cultural comparisons are needed. Conclusion: The results revealed that suicide beautification was negatively associated with positive opinion on suicide prevention efforts after controlling for other variables.

The construction of people in suicide prevention documents

Suicide is a significant issue worldwide and despite comprehensive prevention activities, suicide stigma remains. To explore this issue, we used critical discourse analysis to examine how Australian suicide prevention documents (n = 8) constructed people living with thoughts of suicide. We found that risk and biomedical discourses dominated, with people experiencing suicide ideation constructed as dangerous, different, lacking coping skills, and burdensome. We propose that future suicide prevention activities address potentially stigmatizing language, broaden support and advocacy options, and meaningfully include people with lived experience of suicidal ideation or behavior in the development of policy and interventions.

Sociocultural factors associated with attitudes toward suicide in Australia

To investigate the role of cultural and economic factors on suicide attitudes and stigma toward suicide, we recruited 230 Australian adults for an online survey, assessing demographic characteristics (including ethnicity and socioeconomic status, SES), suicide attitudes, stigma toward people who die by suicide, and public knowledge of suicide prevention (suicide literacy). Regression analyses indicated that participants affiliated with non-Anglo cultures or with higher SES had higher suicide stigma and lower suicide literacy than Anglo participants and those in lower SES areas. Increased stigma in minority cultural groups may impact help-seeking behaviors that protect against suicide.

Development and evaluation of e-mental health interventions to reduce stigmatization of suicidality - a study protocol

BACKGROUND

Worldwide, approximately 800,000 persons die by suicide every year; with rates of suicide attempts estimated to be much higher. Suicidal persons often suffer from a mental disorder but stigma, lack of available and suitable support, and insufficient information on mental health limit help seeking. The use of internet-based applications can help individuals inform themselves about mental disorders, assess the extent of their own concerns, find local treatment options, and prepare for contact with health care professionals. This project aims to develop and evaluate e-mental health interventions to improve knowledge about suicidality and to reduce stigmatization of those affected. In developing these interventions, a representative telephone survey was conducted to detect knowledge gaps and stigmatizing attitudes in the general population.

METHODS

First, a national representative telephone survey with N = 2000 participants in Germany was conducted. Second, e-mental health interventions are developed to address knowledge gaps and public stigma detected in the survey. These comprise an evidence-based health information package about suicidality, information on regional support services, a self-administered depression test-including suicidality-and an interactive online intervention including personal stories. The development is based on a trialogical exchange of experience between persons affected by suicidality, relatives of affected persons, and clinical experts. Australian researchers who developed an e-mental health intervention for individuals affected by rural suicide were invited to a workshop in order to contribute their knowledge and expertise. Third, the online intervention will be evaluated by a mixed methods design.

DISCUSSION

From representative telephone survey data, content can be developed to address specific attitudes and knowledge via the e-mental health interventions. These interventions will be easily accessed and provide an opportunity to reach people who tend not to seek professional services, prefer to inform themselves in advance and/or wish to remain anonymous. Evaluation of the online intervention will provide information on any changes in participants' self-stigma and perceived-stigma of suicidality, and any increase in participants' knowledge on suicidality or self-efficacy expectations.

TRIAL REGISTRATION

German Clinical Trial Register DRKS00015071 on August 6, 2018.

The relationship between an electronic mental health stigma campaign and suicidal thoughts and behaviours: a two-arm randomized controlled trial in the Australian construction industry

Males employed in the construction industry are at greater risk of suicide than other employed males. It is plausible that a high level of stigma against mental health problems explains the elevated rates of suicide among this group. This study sought to test the effectiveness of an electronic mental health stigma intervention on suicide ideation, communication about suicide and attempts. Participants were randomly assigned to receive either a series of brief contact interventions over a 6-week period or a wait list control. Suicidal ideation, communication about suicide and suicide attempts were assessed using the Suicidal Behaviors Questionnaire-Revised at post-intervention. We used linear regression to assess effectiveness at post-intervention, adjusting for relevant covariates using both conventional methods and a propensity score approach. Results indicate that the intervention had no significant impact on suicidal thoughts, communication or suicide attempts. There was some indication that individuals in the intervention group reported a slight increase in attempts and communication about suicide. These observations underscore an urgent need for more research to understand the complex and nuanced relationship between stigma and suicide in non-clinical populations.

Psychometric evaluation of the Questionnaire on Attitudes Towards Suicide (ATTS) in Poland

The Questionnaire on Attitudes Towards Suicide (ATTS) is widely used to evaluate the views of an individual regarding acceptability of suicide and orientation towards suicide prevention. However, recent findings suggest that it requires some revision. The present study examines the factor structure of the ATTS questionnaire in two Polish samples, consisting of 239 students (sample one) and 128 students (sample two) of the helping professions. The previously-established 10-factor model was not supported by confirmatory factor analysis (CFA). Theoretical revaluation of the scale followed by factor analysis suggested that the best fit was provided by a five-factor model accounting for 48.2% of the variance. The adapted Polish ATTS questionnaire showed satisfactory reliability and validity; however, the factor loading patterns and factor structure varied from earlier studies. These improvements in the ATTS theoretical base and construct validity may enhance the utility of the revised scale.

Development and Validity of the Personal Suicide Stigma Questionnaire (PSSQ)

Background: The detrimental consequences of stigma have been recognized in extensive research on mental illness stigma, but experiences of suicide-related stigmatization have not received sufficient research attention. The lack of a simple self-report assessment of personal suicide-related stigma led to the work reported here. Aim: To develop and assess the validity of the Personal Suicide Stigma Questionnaire (PSSQ). Method: The item pool for PSSQ was based on qualitative data and was tested in a community sample of 224 adults (mean age = 32.68 years, 83% female, 92.9% Caucasian) who reported lifetime suicidality. Factor analysis was used for item selection. The Self-Stigma of Mental Illness Scale - Short form (SSMIS-SF) and Suicide Behaviors Questionnaire - Revised (SBQ-R) were used to assess validity of the scale. Results: Following analysis, 16 items, forming three highly interrelated factors (Rejection, Minimization, and Self-blame), were selected for the PSSQ. The PSSQ scores showed predicted relationships with mental illness stigma and suicidality, suggesting its validity. Limitations: The validity of the scale still requires further research in clinical populations. Conclusion: The newly developed PSSQ can be used to assess the levels of suicide-related stigma experiences of suicidal individuals.

A survey of Canadian and Australian pharmacists' stigma of suicide

Background

There is limited information available regarding community pharmacists' stigma of suicide. Pharmacists regularly interact with people at risk of suicide and stigmatizing attitudes may impact care.

Objective

To measure community pharmacists' stigma of suicide.

Method

Pharmacists in Canada and Australia completed an online survey with the Stigma of Suicide Scale-Short Form. Data were analysed descriptively and with univariate and multivariate analyses.

Results

Three hundred and ninety-six pharmacists returned completed surveys (Canada n = 235; Australia n = 161; female 70%; mean age = 38.6 ± 12.7 years). The rate of endorsement of stigmatizing terms was low overall. Canadian and Australian pharmacists differed (p < 0.05) for several variables (e.g. age, friend or relative with a mental illness, training in mental health crisis). Pharmacists without someone close to them living with a mental illness were more likely to strongly agree/agree with words describing those who die by suicide as pathetic, stupid, irresponsible, and cowardly. Those without a personal diagnosis of mental illness strongly agreed/agreed with the terms immoral, irresponsible, vengeful, and cowardly. More Australian pharmacists strongly agreed/agreed that people who die by suicide are irresponsible, cowardly, and disconnected. Independent variables associated with a higher stigma were male sex, Australian, and negative perceptions about suicide preventability.

Conclusion

Community pharmacists frequently interact with people at risk of suicide and generally have low agreement of stigmatizing terms for people who die by suicide. Research should focus on whether approaches such as contact-based education can minimize existing stigma.