Development and pilot evaluation of an online psychoeducational program for suicide prevention among university students: A randomised controlled trial

A web-based video messaging intervention for suicide prevention in men: study protocol for a five-armed randomised controlled trial

BACKGROUND

More than 50% of people who die by suicide have not been in contact with formal mental health services. The rate of people who fly 'under the radar' of mental health services is higher among men than women, indicating a need to improve engagement strategies targeted towards men who experience suicidal thoughts and/or behaviours. In Australia, a range of mental health support services exist, designed specifically for men, yet, a substantial proportion of men do not use these services. The aim of this study is to evaluate whether a brief online video-based messaging intervention is an effective approach for encouraging men with suicidal thoughts and/or behaviours to engage with existing support services.

METHODS

Informed by a literature review, surveys, and consultation with men with a lived experience of suicidal thoughts and/or behaviours, we designed five video-based messages that will be used in this five-arm randomised controlled trial. A total of 380 (76 per arm) men aged 18 years or older with suicidal thoughts who are not currently accessing formal mental health services will be recruited online and randomly assigned to watch one of the five web-based video messages. After viewing the video, men will be presented with information about four existing Australian support services, along with links to these services. The primary outcome will be help-seeking, operationalised as a click on any one of the four support service links, immediately after viewing the video. Secondary outcomes include immediate self-reported help-seeking intentions in addition to self-reported use of the support services during a 1-week follow-up period. We will also use the Discrete Choice Experiment methodology to determine what aspects of support services (e.g. low cost, short appointment wait times) are most valued by this group of men.

DISCUSSION

This study is the first to evaluate the effectiveness of a brief web-based video messaging intervention for promoting engagement with existing support services among men with suicidal thoughts who are not currently receiving formal help. If found to be effective, this would represent a scalable, cost-effective approach to promote help-seeking for this at-risk population. Limitations and strengths of this study design are discussed.

Thirteen years progress: a scoping review of suicide prevention initiatives in post-secondary settings

Objective: Describe the literature on suicide prevention initiatives (SPIs) in post-secondary settings internationally since 2010. Methods: A scoping review and bibliographic search were conducted across MEDLINE, PsycINFO, CINAHL, and Scopus. Two reviewers independently screened articles and extracted data in consultation with a community social work team. Included articles described SPIs in post-secondary settings. Secondary sources and articles unavailable in English were excluded. Results: After identifying 931 citations, 76 articles representing five continents were included. Included articles spanned 2010 to 2023. Most articles represented North America, used quantitative methods, and focused on gatekeepers. SPIs in post-secondary settings were characterized by standardized and commercially available training programs and a wide variety of 'in-house' initiatives unique to campus communities. Conclusions: The quantity of research on SPIs in post-secondary settings has not kept pace with escalating mental health issues and the extent to which suicide is an urgent public health issue for young adults.

Supports for university counselors impacted by student suicide: A systematic review and thematic synthesis

The purpose of this systematic review and thematic synthesis was to identify and consolidate research on the support needs of impacted Higher Education (HE) counselors that have experienced a student suicide death. When exposed to a student suicide death, counselors are often extensively involved in a postvention response. This systematic review synthesized four qualitative papers that explored the experiences of staff impacted by student suicide. Thematic synthesis revealed three core themes: The unknown, responding, and the known, and six subthemes: Gaps in knowledge of individual experience, gaps in knowledge of organizational impact, extrospective responding, introspective responding, the needs of impacted counselors, the degree of impact, and the support processes that arise from needs. The results provide a summary of the current supports available to impacted HE counselors and considerations relevant to their postvention needs.

Educational agents and institutions called into action in suicide prevention, intervention, and postvention

Introduction

Suicide is the second leading cause of death in the 15 to 29 age group worldwide, and is a severe public health problem. Adolescent and young adult individuals attend educational institutions which can play an essential role in detecting and preventing suicide. For this reason, the purpose of this research is to identify what educational institutions and agents are called into action in suicide prevention, intervention, and postvention.

Methods

The method of systematic review of the literature based on the PRISMA protocol was used. The review protocol was registered in PROSPERO (PROSPERO 2020 CRD42020189127). The systematic review yielded 66 articles published between 1990 and February 2023.

Results

The results show that a wide variety of educational stakeholders are required to intervene for suicide prevention, interventions and postvention between primary education and college. The study describes the different programs that have been provided, the countries in which they have been implemented and the agents who have been targeted. It also identifies gaps in the research on suicide in the educational field.

Discussion

Overall, educational suicide initiatives report positive effects on participants' understanding, attitudes, and beliefs regarding suicide and suicide prevention, although some studies have expressed some caution.

Interventions for youth suicide and suicide-related behaviour: An update to a systematic review

OBJECTIVE

To update our 2018 review with the latest evidence from randomised controlled trials (RCTs) on the effectiveness of interventions to prevent youth suicide and suicide-related behaviour.

METHOD

In keeping with our 2018 review, Embase, PsycInfo, and Medline were searched using relevant key words. Included trials were RCTs evaluating the impact of an intervention or approach designed to prevent or reduce youth suicide and suicide-related behaviour. Key data were extracted, and results synthesised narratively.

RESULTS

Thirty RCTs were included across clinical (n = 13), educational (n = 8), and community settings (n = 9). No trials were conducted in workplace or primary care settings, or with indigenous populations, and few trials involved partnerships with young people. There were some concerns or a high risk of bias for most trials.

CONCLUSION

While a relatively large number of RCTs have been published in recent years, knowledge gaps remain. Further high-quality RCTs are needed, including those focussing on vulnerable population groups. Meaningful consumer involvement and a stronger emphasis on implementation are also recommended.

Crisis-management, Anti-stigma, and Mental Health Literacy Program for University Students (CAMPUS): A preliminary evaluation of suicide prevention

Background: University students have specific risk factors for suicide, necessitating targeted prevention programs. This preliminary study evaluated the efficacy of the Crisis-management, Anti-stigma, Mental health literacy Program for University Students (CAMPUS) for reduction of risk factors and promotion of preventative behaviors. Methods: A total of 136 medical students attended the CAMPUS as a required course at the national university in Japan. The CAMPUS consisted of a lecture and two group sessions covering mental health literacy, self-stigma, and gatekeeper efficacy (e.g., identifying and helping at-risk individuals). The students were asked to role-play based on a movie about gatekeepers and scripts about self-stigma and suicide-related issues. Participants completed questionnaires on suicidal thoughts, depression, help-seeking intentions, self-efficacy as gatekeepers, self-concealment, and self-acceptance. A total of 121 students completed the questionnaires pre- and post-program, and 107 students also responded six months later. Results: Students demonstrated significantly reduced overall suicide thoughts six months post-program compared to before the program. In addition, gatekeeper self-efficacy, help-seeking intentions for formal resources, and self-acceptance were improved in the students six month after the program. Conclusions: The CAMPUS suggested effective at reducing suicidal people and promoting preventative psychological tendencies among medial students. This study was a one-group pre post design study without control group. The CAMPUS program was delivered as a mandatory requirement to a group with relatively low suicide risk. Further studies are required to assess its suitability for the general university student population.

Evaluation of an online suicide prevention program to improve suicide literacy and to reduce suicide stigma: A mixed methods study

Low-threshold e-health approaches in prevention to reduce suicide stigma are scarce. We developed an online program containing video reports on lived experience of suicide and evidence-based information on suicidality. We evaluated the program by a mixed methods design. We examined pre-post-changes of program completers (n = 268) in suicide literacy, suicide stigma (self and perceived), and self-efficacy expectation of being able to seek support in psychologically difficult situations using linear mixed models. To examine reported changes and helpful program elements 12-26 weeks after program completion, we content analyzed transcripts of telephone interviews (n = 16). Program completers showed more suicide literacy (Cohen's d = .74; p < .001), higher self-efficacy expectations to seek support (d = .09; p < .01), lower self-stigma (subscales glorification/normalization: d = -.13, p = .04; isolation/depression: d = -.14; p = .04; stigma: d = -.10; p = .07; n = 168) compared to baseline. We found no significant differences in perceived suicide stigma. We identified lived experience reports, the possibility of sharing own narrative on stigma and suicidality, and information on support as helpful elements. The current online program can increase suicide literacy and self-efficacy expectations to seek support and reduce self-stigma. We recommend a larger randomized controlled trial with longer follow-up to confirm these findings.

A multicomponent digital intervention to promote help-seeking for mental health problems and suicide in sexual and gender diverse young adults: A randomized controlled trial

BACKGROUND

LGBTQ+ community's higher susceptibility to worse mental health outcomes and more help-seeking barriers compared to the cis-heterosexual population. Despite the LGBTQ+ population facing higher mental health risks, there has been a dearth of research focusing on developing tailored interventions targeting them. This study aimed to assess the effectiveness of a digital multicomponent intervention in promoting help-seeking for mental health issues in LGBTQ+ young adults.

METHODS AND FINDINGS

We recruited LGBTQ+ young adults aged between 18 and 29 who scored moderate or above on at least 1 dimension of the Depression Anxiety Stress Scale 21 and did not have help-seeking experiences in the past 12 months. Participants (n = 144) were stratified by gender assigned at birth (male/female) and randomly allocated (1:1 ratio) to the intervention or active control parallel condition by generating a random number table, so they were blinded to the intervention condition. All participants received online psychoeducational videos, online facilitator-led group discussions, and electronic brochures in December 2021 and January 2022, with the final follow-up in April 2022. The contents of the video, discussion, and brochure are help-seeking for the intervention group and general mental health knowledge for the control group. The primary outcomes were help-seeking intentions for emotional problems and suicidal ideation and attitudes toward seeking help from mental health professionals at the 1-month follow-up. The analysis was performed by including all participants based on their randomized group regardless of adherence to the protocol. A linear mixed model (LMM) was used for analysis. All models were adjusted for baseline scores. Chinese Clinical Trial Registry: ChiCTR2100053248. A total of 137 (95.1%) participants completed a 3-month follow-up, and 4 participants from the intervention condition and 3 from the control condition did not complete the final survey. Compared with the control group (n = 72), a significant improvement was found in help-seeking intentions for suicidal ideation in the intervention group (n = 70) at post-discussion (mean difference = 0.22, 95% CI [0.09, 0.36], p = 0.005), 1-month (mean difference = 0.19, 95% CI [0.06, 0.33], p = 0.018), and 3-month follow-ups (mean difference = 0.25, 95% CI [0.11, 0.38], p = 0.001). There was also a significant improvement in the intervention condition on the help-seeking intention for emotional problems at 1-month (mean difference = 0.17, 95% CI [0.05, 0.28], p = 0.013) and 3-month follow-ups (mean difference = 0.16, 95% CI [0.04, 0.27], p = 0.022) compared with the control group. Participants' depression and anxiety literacy and help-seeking encouragement related knowledge in intervention conditions showed significant improvements. There were no significant improvements in actual help-seeking behaviors, self-stigma toward seeking professional assistance, depression, and anxiety symptoms. No adverse events or side effects were observed. However, the follow-up time point was limited to 3 months which might not be long enough for drastic mindset and behavioral changes in help-seeking to occur.

CONCLUSIONS

The current intervention was an effective approach in promoting help-seeking intentions, mental health literacy, and help-seeking encouragement-related knowledge. Its brief yet integrated intervention format could also be utilized in treating other imminent concerns confronted by LGBTQ+ young adults.

TRIAL REGISTRATION

Chictr.org.cn, ChiCTR2100053248.

Attitudes towards suicidal behavior: the effect of an educational intervention on university professors

OBJECTIVE

To analyze the effect of an educational intervention on the attitudes of university professors towards suicidal behavior.

METHODS

Experimental study, which carried out an educational intervention with 100 university professors, divided into two groups, control and intervention, developed in three moments, pre-assessment, intervention, and post-assessment, using the Eskin's Attitudes Towards Suicide Scale (E-ATSS). Comparisons before and after intervention in the same group were performed using the paired t-test for dependent samples and the Wilcoxon Signed Rank Test, and for comparisons between groups the paired t-test for independent samples and the Mann-Whitney U test were used, the significance level adopted was p < 0.05.

RESULTS

There was a change in the attitude of professors in the two domains of the suicide scale such as mental illness (p<0.001) and punishment after death (p<0.001) whose attitudes were negative in the pre-assessment phase. For the control group, no changes were observed.

CONCLUSION

The educational intervention promoted positive changes in attitudes, with a significant change evaluated at the end of the intervention in the domains: suicide as mental illness and punishment after death.

The impact of digital interventions on help-seeking behaviour for mental health problems: a systematic literature review

PURPOSE OF REVIEW

Interventions that facilitate help-seeking could help individuals to get care earlier on which could also help avert some mental health crises. Delivering interventions via a digital format could mitigate some key barriers to mental healthcare. We reviewed the literature for digital interventions which facilitate formal or informal help-seeking for mental health problems. We examined the impact of identified interventions on actual and intended help-seeking and attitudes towards help-seeking.

RECENT FINDINGS

We identified 35 interventions. About half (51%) of studies showed an improvement in at least one help-seeking outcome with the greatest number showing an improvement in help-seeking intentions and the fewest studies showing an improvement in actual behaviour (29%). Findings suggest that interventions that promote active participation and personal involvement through sharing one's own narrative seem to be promising practices to facilitate help-seeking.

SUMMARY

Our findings suggest digital interventions can improve help-seeking for mental health problems among a range of populations. Given speciality mental health resources are scarce, further research needs to consider how these interventions could best target the most vulnerable groups to link them with mental healthcare and how these interventions might facilitate earlier intervention in a way that might reduce need for crisis care and support.

Storytelling of suicide attempt recovery and its relationship with mental health treatment-seeking attitudes and behaviors: An experimental study

ObjectiveThis experimental study investigated if watching a brief video detailing an individual's recovery following a suicide attempt increased college student mental health treatment-seeking attitudes and resource engagement more than viewing a psychoeducational video about suicide. Participants: Undergraduate student participants (N = 218) completed the study online. Methods: Participants were randomized to see either the storytelling or one of two narrated psychoeducation videos and complete self-report measures following video viewing. Results: Video condition as well as its interaction with levels of identification with the storyteller/video narrator generally did not predict treatment-seeking attitudes as hypothesized. A small but not statistically significant effect for immediate resource engagement was seen as those in the storytelling condition interacted with online suicide prevention more than those in one of the psychoeducation conditions. Conclusions: These results suggest that brief viewing of storytelling about lived experience with suicide may have minimal impact on treatment-seeking propensity in college students.

Internet-based interventions to promote help-seeking for mental health in LGBTQ+ young adults: Protocol for a randomized controlled trial

BACKGROUND

Compared to its cis-heterosexual counterpart, the sexual and gender minority (SGM) population is disproportionately susceptible to mental health problems, including depression, anxiety, and minority stress. They are also facing unique help-seeking barriers when in need of support. Past research has shown promising results in using interventions to promote help-seeking intentions and attitudes of the cis-heterosexual population. However, there were no known help-seeking interventions targeting the SGM population. This protocol illustrates a study design to test the efficacy of a newly-developed internet-based program aimed to promote help-seeking for mental health in LGBTQ+ young adults.

METHODS

This study is a randomized controlled trial that aims to promote and improve the SGM young adults' help-seeking by integrating animated psychoeducational videos, group discussion, and the SGM youth help-seeking brochure. Primary outcomes, including help-seeking intentions and attitudes, will be measured at baseline, post-intervention, one-month post-intervention, and three-month post-intervention. The secondary outcomes, including help-seeking stigma, help-seeking literacy, mental health literacy, and help-seeking behaviors, will be measured at the same time points.

DISCUSSION

This is an internet-based, multi-dimensional, and integrative intervention tailored to the needs of the SGM population. It addresses an important gap in the current landscape of mental health promotion for the SGM population. The findings from this trial will provide new knowledge on promoting help-seeking among the SGM population, paving the road for future research that focuses on addressing mental health issues faced by the SGM population.

TRIAL REGISTRATION

Chictr.org.cn: ChiCTR2100053248.

Atitudes frente ao comportamento suicida: o efeito de uma intervenção educativa em docentes universitários

RESUMO Objetivo: Analisar o efeito de uma intervenção educativa nas atitudes de docentes universitários frente ao comportamento suicida. Métodos: Estudo experimental, que realizou uma intervenção educativa com 100 docentes universitários, divididos em dois grupos, controle e intervenção, desenvolvido em três momentos, a pré-avaliação, intervenção e pós avaliação, utilizando a Escala Eskin de Atitudes em Relação ao Suicídio (E-ATSS). As comparações pré e pós-intervenção no mesmo grupo foram realizadas a partir do Teste t pareado para amostras dependentes e Teste de Postos com Sinais de Wilcoxon, e para comparações entre os grupos utilizou-se o Teste t pareado para amostras independentes e Teste U-Mann Whitney, nível de significância adotado foi de p < 0,05. Resultados: Observou-se mudança de atitude dos docentes nos dois domínios da escala suicídio como doença mental (p< 0,001) e punição após a morte (p< 0,001) cujas atitudes eram negativas na fase pré-avaliação. Para o grupo controle não foram evidenciadas modificações. Conclusão: A intervenção educativa promoveu mudanças positivas de atitudes, com significativa alteração avaliada ao final da intervenção nos domínios: suicídio como doença mental e punição após a morte.

The "Talk-to-Me" MOOC intervention for suicide prevention and mental health education among tertiary students: Protocol of a multi-site cross-over randomised controlled trial

INTRODUCTION

Mental health problems are common among tertiary education students, with concerning levels of suicide ideation frequently observed in this population. There is a need for evidence-based mental health education and suicide prevention programs designed to meet the specific needs of these students. The "Talk-to-Me" Mass Open Online Course (MOOC) is a strengths-based mental health education program underpinned by a six-phase model for managing a suicidal crisis.

METHODS

To evaluate the efficacy of the "Talk-to-Me" MOOC in improving student knowledge of appropriate responses to suicide crisis via a randomised control trial (RCT) comparing tertiary education health science and education students attending the program to a waitlist control group. Overall, 170 will be screened and randomly allocated to either the "Talk-to-Me" MOOC or a waitlist control group, with data collection occurring at three-time points (baseline, 10-weeks and 24-weeks from baseline) over one year. The primary outcome will be participants' knowledge and responses to suicidal statements as measured by the Suicide Intervention Response Inventory. Secondary outcomes will be knowledge of mental health and coping skills as well as the overall utility of the program.

CONCLUSIONS

This pragmatic RCT will demonstrate the efficacy of the "Talk-to-Me" MOOC in improving the students' ability to respond to suicidal and mental health concerns compared to the waitlist group. This design will enable rigorous evaluation of the "Talk-to-Me" MOOC, contributing to a greater understanding of the online-delivered safe-paced suicide prevention programs for tertiary students. Australian New Zealand Clinical Trials Registry (ANZCTR): #12619000630112.

Preventing suicide in post-secondary students: a scoping review of suicide prevention programs

Suicide among students enrolled in post-secondary education, including university or college, is a major public health concern. Previous research has examined the effectiveness of suicide prevention programs for this population. However, the effective elements of these interventions remain unknown. This study reviewed the literature on suicide prevention programs for post-secondary students, exploring and identifying those elements likely contributing to their effectiveness. A scoping review process was undertaken exploring suicide prevention programs for post-secondary students. Methodological quality of the articles was assessed, and content analysis was used to explore the programs and their effective elements. Twenty seven articles were included in this review, covering a variety of approaches. Gatekeeper training programs were the most common type of suicide prevention program. Programs for post-secondary students may be effective in improving student rates of engagement with mental health services and were associated with greater knowledge, and help-seeking attitudes and behaviors, and gatekeeper-related outcomes. While evidence was found supporting the effectiveness of some interventions such as gatekeeper programs to influence suicide-related knowledge, attitudes and behaviour, further and more rigorous research surrounding suicide prevention programs for post-secondary students is required, with a particular emphasis on student outcomes.

Factors associated to suicide risk in stricto sensu postgraduate students: a cross-sectional study

OBJECTIVE

to analyze factors associated to suicide risk in postgraduate students.

METHOD

a cross-sectional analytical study, developed with 565 stricto sensu postgraduate students from August to September 2019. Data collection took place using a validated instrument containing demographic, socioeconomic, health and academic variables; as well as variables of Module C of the Mini International Neuropsychiatric Interview (MINI), version 5.0; of the CAGE (Cut down, Annoyed by criticism, Guilty and Eye-opener) questionnaire; and the Depression, Anxiety and Stress Scale (DASS-21). Descriptive and multiple statistical analysis was performed using the Poisson regression model, with a significance level of 5%.

RESULTS

40.8% prevalence of current suicide risk. The following variables were associated to current suicide risk: age > 30 years old (p=0.029), absence of faith (p=0.015), depression (p<0.001) and anxiety (p=0.018) symptoms, use of psychotropic drugs during the course (p<0.001), not having a meaningful and inspiring academic work (p=0.013), not having a good relationship with colleagues from the postgraduate school (p=0.033), having family relationship impaired by the demands of the postgraduate school (p=0.036) and concern about the financial situation (p=0.048).

CONCLUSION

a high prevalence of current suicide risk was identified among postgraduate students, as well as a significant association of this risk with demographic, socioeconomic, academic and health variables.

Innovating Technology-Enhanced Interventions for Youth Suicide: Insights for Measuring Implementation Outcomes

Technology is one medium to increase youth engagement, especially among underserved and minority groups, in suicide preventive interventions. Technology can be used to supplement or adjunct an in-person intervention, guide an in-person intervention, or be the stand-alone (automated) component of the intervention. This range in technological use is now called the continuum of behavioral intervention technologies (BITs). Overall, suicide intervention researchers do not use this terminology to categorize how the role of technology differs across technology-enhanced youth interventions. There is growing recognition that technology-enhanced interventions will not create substantial public health impact without an understanding of the individual (youth, families, and providers), mezzo (clinics and health systems of care), and contextual factors (society, culture, community) that are associated with their implementation. Implementation science is the study of methods to promote uptake of evidence-based practices and policies into the broader health care system. In this review, we incorporate work from implementation science and BIT implementation to illustrate how the study of technology-enhanced interventions for youth suicide can be advanced by specifying the role of technology and measuring implementation outcomes.

Overview of a new eHealth intervention to promote healthy eating and exercise in pregnancy: Initial user responses and acceptability

PURPOSE

The purpose of this project was to develop and evaluate an eHealth intervention to promote healthy lifestyle for pregnant women. The setting was a low socio-economic and multi-ethnic area in Melbourne, Australia.

METHODS

This paper briefly describes the development of the eHealth intervention, which was aimed at a low level of literacy, and the evaluation of the intervention by pregnant women. A basic descriptive survey was undertaken to evaluate user friendliness, usefulness and acceptability of the intervention.

RESULTS

The intervention was developed by a team of experts and forty pregnant women participated in the evaluation. Results indicated that participants found the intervention informative, useful and easy to navigate. They also identified some minor areas for improvement which will be addressed prior to proceeding to a formal controlled evaluation.

CONCLUSION

Results from this evaluation are encouraging and suggest that women found the intervention convenient, trustworthy and engaging. Most enjoyed navigating the website information. As such, it is likely to prove a useful support for delivering dietary and exercise information to pregnant women in the local low socio-economic area. Further formal evaluation will test the efficacy of the website in improving diet and exercise outcomes during pregnancy.

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).

A Mobile Health Intervention (LifeBuoy App) to Help Young People Manage Suicidal Thoughts: Protocol for a Mixed-Methods Randomized Controlled Trial

BACKGROUND

Self-help smartphone apps offer a new opportunity to address youth suicide prevention by improving access to support and by providing potentially high fidelity and cost-effective treatment. However, there have been very few smartphone apps providing evidence-based support for suicide prevention in this population. To address this gap, we developed the LifeBuoy app, a self-help smartphone app informed by dialectical behavior therapy (DBT), to help young people manage suicidal thoughts in their daily life.

OBJECTIVE

This study describes the protocol for a randomized controlled trial to evaluate the efficacy of the LifeBuoy app for reducing suicidal thoughts and behaviors, depression, anxiety, and psychological distress, and improving general mental well-being in young adults aged 18 to 25 years.

METHODS

This is a randomized controlled trial recruiting 378 young adults aged between 18 and 25 years and comparing the LifeBuoy app with a matched attention control (a placebo app with the same display but no DBT components). The primary outcome is suicidal thoughts measured by the Suicidal Ideation Attributes Scale (SIDAS). The secondary outcomes are suicidal behavior, depression, anxiety, psychological distress, and general mental well-being. The changes in the levels of insomnia, rumination, suicide cognitions, distress tolerance, loneliness, and help seeking before and after using the app are evaluated in this study. The study also addresses risk factors and responses to the intervention. A series of items assessing COVID-19 experiences is included in the trial to capture the potential impact of the pandemic on this study. Assessments will occur on the following three occasions: baseline, postintervention, and follow-up at 3 months postintervention. A qualitative interview about user experience with the LifeBuoy app will take place within 4 weeks of the final assessment. Using linear mixed models, the primary analysis will compare the changes in suicidal thoughts in the intervention condition relative to the control condition. To minimize risks, participants will receive a call from the team clinical psychologist by clicking a help button in the app or responding to an automated email sent by the system when they are assessed with elevated suicide risks at the baseline, postintervention, and 3-month follow-up surveys.

RESULTS

The trial recruitment started in May 2020. Data collection is currently ongoing.

CONCLUSIONS

This is the first trial examining the efficacy of a DBT-informed smartphone app delivered to community-living young adults reporting suicidal thoughts. This trial will extend knowledge about the efficacy and acceptability of app-based support for suicidal thoughts in young people.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378366.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/23655.

The Role of Technology and the Continuum of Care for Youth Suicidality: Systematic Review

Background

Youth suicide is a global public health issue, and using technology is one strategy to increase participation in preventive interventions. However, there is minimal knowledge on how technology-enhanced interventions for youth correspond to the stages of care, from illness or risk recognition to treatment follow-up.

Objective

This systematic review aims to examine the efficacy of technology-enhanced youth suicide prevention and interventions across the continuum of care.

Methods

Four electronic databases were searched up to spring 2019 for youth suicide preventive interventions that used technology. The review was not restricted by study design and eligible studies could report outcomes on suicidality or related behaviors, such as formal treatment initiation. An adapted version of the Methodological Quality Ratings Scale was used to assess study quality.

Results

A total of 26 studies were identified. The findings support the emerging efficacy of technology-enhanced interventions, including a decline in suicidality and an increase in proactive behaviors. However, evidence suggests that there are gaps in the continuum of care and recent study samples do not represent the diverse identities of vulnerable youth.

Conclusions

The majority of identified studies were conducted in school settings and were universal interventions that aligned with the illness and risk recognition and help-seeking stages of the continuum of care. This field could be strengthened by having future studies target the stages of assessment and treatment initiation, include diverse youth demographics, and examine the varying roles of providers and technological components in emerging interventions.

Depression, anxiety and stress in different subgroups of first-year university students from 4-year cohort data

BACKGROUND

Limited studies have been conducted to investigate the mental health status of subgroups of university students. This study hypothesized that there would be differences among student subgroups in the prevalence of depression, anxiety and stress; and association of age, gender, academic performance and mental health status.

METHODS

This was a cross-sectional survey study. Since 2014, first-year university students in a university in Hong Kong were invited to complete the Depression Anxiety Stress Scale (DASS-21) before the commencement of their study. These DASS data were then merged with objectively measured data from university records. 9,479 students completed the DASS survey, this being 56.5% of the total student population in the records. Kruskal-Wallis Tests were applied to compare the differences among student subgroups.

RESULTS

Community college transfer (CCT) students were the highest-risk group for depression, anxiety and stress, and their study load was the highest as well. Unexpectedly, mainstream students ranked after the CCT students in the prevalence and levels of depression, anxiety and stress. Student athletes had the highest prevalence of depression. Although there were declining trends for depression, anxiety and stress, it was only a slight drop. Overall, age, gender, study load and academic performance were associated with the mental health profile (p<0.05).

LIMITATIONS

After admission, students' mental health conditions could have changed. Further studies are needed to measure mental health during their study.

CONCLUSIONS

Mental health problems were not distributed evenly across different student subgroups, psychological support should be designed according to the needs of each student subgroup.

Attitude Toward Seeking Professional Psychological Help Among Community-Dwelling Population in China

OBJECTIVE

To explore the attitudes and factors in seeking professional psychological help among a Chinese community-dwelling population in order to promote positive help-seeking behaviors and better utilization of mental health services.

METHODS

Using system and simple random sampling with Kish selection table methods, 912 community-dwelling residents were included in this study and asked about their attitudes toward seeking professional psychological help, depression symptoms, family function, depression literacy, help-seeking intention, and stigma.

RESULTS

Scores on the Attitudes Toward Seeking Professional Psychological Help scale (ATSPPH-SF) indicated a neutral attitude toward openness to seeking treatment for psychological problems and a negative attitude toward the value and need to seek treatment with a negative total score. Multiple linear regression analysis showed that gender, age, social support (employment status and family function), depression literacy, stigma, and help-seeking intention are significantly associated with attitude toward seeking professional psychological help.

CONCLUSION

The overall attitude toward seeking professional psychological help is not optimistic, thus, more efforts are needed to enhance understanding. Effective interventions including mental health education, training of mental health professionals, and popularizing the use of mental health services are essential, especially for the at-risk population.

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.

Seeking professional help for suicidal ideation: A comparison between Chinese and Australian university students

Suicide is the second leading cause of death in Chinese university students and research examining their professional help-seeking is limited. This study aims to investigate: (i) professional help-seeking intentions for suicidal ideation among Chinese university students, with comparison to Australian university students, (ii) relationships between suicide literacy, social support, suicide stigma, self-reliance and help-seeking intentions, and (iii) self-recognised barriers to help-seeking. Chinese (N = 208) and Australian (N = 128) university students were recruited to complete an online cross-sectional survey assessing their intentions to seek professional help if they experienced suicidal ideation. One-third of the surveyed Chinese and Australian students expressed reluctance to seek professional help. Self-reliance was endorsed by both countries' university students as an important barrier. Suicide literacy, suicide stigma, and social support were not found to have a significant relationship with help-seeking intentions. The high costs of mental health services (Australian university students) and informal support from family and friends (Chinese university students) were identified as critical barriers to help seeking by participants. Results from this study suggest self-reliance is a potentially important barrier to professional help-seeking, whereas, suicide literacy and suicide stigma may have limited influence on help-seeking intentions among student populations.

Shifting Beliefs about Suicide: Pre-Post Evaluation of the Effectiveness of a Program for Workers in the Construction Industry

Suicide is a significant health problem that is known to disproportionately affect those employed in manual occupations, including construction workers and tradespeople. Universal General Awareness Training (GAT) was part of a multi-component suicide prevention program in the Australian construction industry. The program’s aims were to increase awareness of mental health and suicide, reduce stigma, and encourage help-seeking and help-offering behaviours. This paper sought to examine the effectiveness of the GAT program in shifting suicide beliefs. Pre- and post-training survey data of 20,125 respondents was obtained from a database of GAT evaluation results between 2016 and 2018. Generalized estimating equation (GEE) models were fitted to examine belief changes, and predictive margins and their SEs were computed. Mean differences in belief change were obtained for the overall sample, and by occupation. Modest but significant favourable shifts in three of the four beliefs assessed were observed following GAT. Managers and professionals showed greater propensity to shift beliefs, and Labourers and Machinery Operators and Drivers showed least. Results suggest that GAT can successfully shift some beliefs regarding suicide and mental health at least in the short term, but highlight the need to tailor communication to vulnerable occupational groups.