Widening socioeconomic inequalities in Australian suicide, despite recent declines in suicide rates

Remaining Between the Cracks - The Long-Term Effect of Different Suicide Risk Exclusion Criterion on Outcomes of an Online Intervention for Depression

Background: Previous studies have demonstrated that excluding individuals at risk of suicide from online depression interventions can impact recruited sample characteristics. Aim: To determine if a small change in suicide risk exclusion criterion led to differences in the usage and effectiveness of an Internet depression intervention at 6 months of follow-up. Method: A partial sample of a recently completed online depression intervention trial was divided into two groups: those with no risk of suicide versus those with some risk. The two groups were compared for baseline demographic and clinical measures, as well as intervention uptake and treatment success across 6 months. Results: Overall, individuals with less risk of suicide at baseline reported significantly less severe clinical symptoms. Both groups interacted with the intervention at the same rate, but specific use of modules was different. Finally, the impact of intervention usage on outcomes over time did not vary by group. Limitations: While different suicide risk exclusion criteria can change recruited sample characteristics, it remains unclear how these differences impact intervention uptake and success. Conclusion: Overall, the findings suggest that researchers should exercise caution when excluding individuals at risk of suicide, as they greatly benefit from web-based interventions.

Evaluation of a workplace suicide prevention program in the Australian manufacturing industry: protocol for a cluster-randomised trial of MATES in manufacturing

Males are at higher risk of death by suicide than females in Australia, and among men, blue-collar males are at higher risk compared to other working males. In response, MATES in Construction developed a workplace suicide prevention program for the construction sector in 2007 that has been widely implemented in Australia. In the current project, this program is being adapted and trialled in the manufacturing sector. The common aims of MATES programs are to improve suicide prevention literacy, help-seeking intentions, and helping behaviours. The program will be evaluated using a cluster randomised-controlled trial design with waitlist controls across up to 12 manufacturing worksites in Australia. We hypothesise that after 8 months of the MATES in Manufacturing program, there will be significantly greater improvements in help-seeking intentions (primary outcome) compared to waitlist controls. The project is led by Deakin University in collaboration with the University of Melbourne, and in partnership with MATES in Construction and a joint labour-management Steering Group.Trial registration: The trial was registered retrospectively with the Australian New Zealand Clinical Trials Registry on 25 January 2022 (ACTRN12622000122752).Protocol version: 2.0, November 2022.

Predictors and incidence rate of suicide re-attempt among suicide attempters: A prospective study

OBJECTIVE

Recent investigations and advances include improved understanding of trends, epidemiology, risk and protective factors on suicide. However, predictors of suicide re-attempt are poorly understood in a prospective design, at least in Iran. This prospective study was performed to investigate predictors and epidemiological aspects of suicide re-attempt during a 5-years of follow-up among Suicide Attempters (SAs).

METHODS

All the 1034 SAs of Malekan County were followed up and interviewed from 2014 to 2018. Cox regression analysis was used to estimate crude and adjusted hazard ratios and 95% confidence intervals for suicide re-attempt risk.

RESULTS

The overall prevalence of re-attempt was 117 (11.7%) over 5 years period. The overall incidence and person-time incidence rates of re-attempt were 113.15 per 1000 attempters and 7.1 per 100 person-year, respectively. The majority of re-attempts 161 (81.3%) took place within the first-18 months of follow-up while the peak of re-attempt was 6 months after attempts. In the final analysis, age ≤ 25, family income (≥ 10 million Rials), having any psychiatric disorder, poor education, stressful life events, alcohol abuse, and smoking were the most reliable predictors of suicide re-attempt.

CONCLUSION

Health systems should be informed about the predictors for subsequent SA after any attempt. Appropriate suicide prevention strategies should be tailored to the specific profile of each group for moderating predictors of suicide re-attempt.

Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation

BACKGROUND

Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia.

METHODS

A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010-2015 from the National Coronial Information System.

RESULTS

There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010-2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated.

CONCLUSIONS

Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.

Rethinking Suicide in Rural Australia: A study Protocol for Examining and Applying Knowledge of the Social Determinants to Improve Prevention in Non-Indigenous Populations

Disproportionate rates of suicide in rural Australia in comparison to metropolitan areas pose a significant public health challenge. The dynamic interrelationship between mental and physical health, social determinants, and suicide in rural Australia is widely acknowledged. Advancement of this knowledge, however, remains hampered by a lack of adequate theory and methods to understand how these factors interact, and the translation of this knowledge into constructive strategies and solutions. This paper presents a protocol for generating a comprehensive dataset of suicide deaths and factors related to suicide in rural Australia, and for building a program of research to improve suicide prevention policy and practice to better address the social determinants of suicide in non-indigenous populations. The two-phased study will use a mixed-methods design informed by intersectionality theory. Phase One will extract, code, and analyse quantitative and qualitative data on suicide in regional and remote Australia from the National Coronial Information System (NCIS). Phase Two will analyse suicide prevention at three interrelated domains: policy, practice, and research, to examine alignment with evidence generated in Phase One. Findings from Phase One and Two will then be integrated to identify key points in suicide prevention policy and practice where action can be initiated.

The impact of strengthening mental health services to prevent suicidal behaviour

OBJECTIVE

Successive suicide prevention frameworks and action plans in Australia and internationally have called for improvements to mental health services and enhancement of workforce capacity. However, there is debate regarding the priorities for resource allocation and the optimal combination of mental health services to best prevent suicidal behaviour. This study investigates the potential impacts of service capacity improvements on the incidence of suicidal behaviour in the Australian context.

METHODS

A system dynamics model was developed to investigate the optimal combination of (1) secondary (acute) mental health service capacity, (2) non-secondary (non-acute) mental health service capacity and (3) resources to re-engage those lost to services on the incidence of suicidal behaviour over the period 2018-2028 for the Greater Western Sydney (Australia) population catchment. The model captured population and behavioural dynamics and mental health service referral pathways and was validated using population survey and administrative data, evidence syntheses and an expert stakeholder group.

RESULTS

Findings suggest that 28% of attempted suicide and 29% of suicides could be averted over the forecast period based on a combination of increases in (1) hospital staffing (with training in trauma-informed care), (2) non-secondary health service capacity, (3) expansion of mental health assessment capacity and (4) re-engagement of at least 45% of individuals lost to services. Reduction in the number of available psychiatric beds by 15% had no substantial impact on the incidence of attempted suicide and suicide over the forecast period.

CONCLUSION

This study suggests that more than one-quarter of suicides and attempted suicides in the Greater Western Sydney population catchment could potentially be averted with a combination of increases to hospital staffing and non-secondary (non-acute) mental health care. Reductions in tertiary care services (e.g. psychiatric hospital beds) in combination with these increases would not adversely affect subsequent incidence of suicidal behaviour.

Are Young Men Getting the Message? Age Differences in Suicide Prevention Literacy among Male Construction Workers

Suicide is a leading cause of death among young men. Help-seeking is known to be poor among this group, and little is known about what interventions are most successful in improving suicide prevention literacy among young men. This research aims to examine: (1) age differences in beliefs related to suicide prevention literacy and attitudes to the workplace in addressing mental health among male construction workers; (2) age differences in response to a workplace suicide prevention program. Pre- and post-training survey data of 19,917 male respondents were obtained from a workplace training program database. Linear regression models and predictive margins were computed. Mean differences in baseline beliefs, and belief change were obtained for age groups, and by occupation. Young men demonstrated poorer baseline suicide prevention literacy but were more likely to consider that mental health is a workplace health and safety issue. There was also evidence that young men employed in manual occupations had poorer suicide prevention literacy than older men, and young men employed in professional/managerial roles. The youngest respondents demonstrated the greatest intervention-associated change (higher scores indicating more favourable belief change) to People considering suicide often send out warning signs (predicted mean belief change 0.47, 95% CI 0.43, 0.50 for those aged 15–24 years compared to 0.38, 95% CI 0.36, 0.41 for men aged 45 years and over), and to The construction industry must do something to reduce suicide rates (predicted mean belief change 0.17, 95% CI 0.15, 0.20 for those aged 15–24 years compared to 0.12, 95% CI 0.10, 0.14 among men aged 45 years and over). Results indicate that while suicide prevention literacy may be lower among young men, this group show amenability to changing beliefs. There were some indications that young men have a greater propensity to regard the workplace as having a role in reducing suicide rates and addressing mental health, highlighting opportunity for workplace interventions.