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Due AS, Madsen T, Hjorthøj C, Ranning A, Calear AL, Batterham PJ, Nordentoft M, Erlangsen A. People who die by suicide without having attended hospital-based psychiatric care: Who are the ones that do not seek help? J Affect Disord 2024; 368:655-664. [PMID: 39293599 DOI: 10.1016/j.jad.2024.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 09/10/2024] [Accepted: 09/14/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Little is known regarding those who die by suicide without having received help. The aim of this study was to compare those who died by suicide without having attended psychiatric care with controls (a) with a psychiatric diagnosis and (b) from the general population. METHODS Cases were all individuals 15+ who lived in Denmark during 2010-2021 and had died by suicide without having attended hospital-based psychiatric care. Cases were matched to controls from the two comparison-groups using a 1:10 ratio and compared using age-and sex-adjusted logistic regression analyses. Geographical variations in psychiatric care utilization were examined. RESULTS Among 7119 individuals who died by suicide, 3474 (48.8 %) had not attended psychiatric care. Compared to controls with a psychiatric diagnosis, cases were more likely to be male (OR, 3.9, 95% CI, 3.6-4.2), older (80+ years: OR, 10.7, 95 % CI, 9.2-12.5), have lost a close relative (OR, 1.8, 95 % CI, 1.3-2.6) or recently retired (OR, 1.4, 95 % CI, 1.0-1.1.8). Compared to controls from the general population, cases were associated with male sex (OR, 4.6, 95 % CI, 4.2-5.0), living alone (OR, 2.3, 95 % CI, 2.2-2.5), unemployment (OR, 2.1, 95 % CI, 1.8-2.5), as well as having lost a close relative (OR, 5.0, 95 % CI, 3.5-7.2) or divorced within the last 1 year (OR, 3.6, 95 % CI, 2.7-4.9). LIMITATIONS Characteristics and preceding events were limited to available register data. CONCLUSIONS About half of all who died by suicide had not attended psychiatric care. Being older, male, or exposed to recent stressors were some of the major markers when compared to controls.
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Affiliation(s)
- Ada Synnøve Due
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Section of Epidemiology, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Section of Epidemiology, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Anne Ranning
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Alison L Calear
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Fulginiti A, Doyle M, Miller S, Lee S, Pasquarella FJ. Follow-Up Care Offers and Acceptance in Crisis Line Suicide Prevention Services. CRISIS 2024. [PMID: 39252531 DOI: 10.1027/0227-5910/a000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background: Prior work has explored the impact of follow-up calls in a crisis line context, but no research has investigated the offer and acceptance of follow-up care. Aims: To identify caller/call characteristics associated with whether a caller is offered and accepts follow-up services. Methods: This cross-sectional study included data from 55,594 callers to a member center of the 988 Suicide & Crisis Lifeline (988) between 2017 and 2019. Logistic regression analyses were conducted to examine associations between caller/call characteristics and two follow-up outcomes. Results: Black callers and those with higher suicide capability and intent had greater odds of being offered and accepting follow-up. Longer call duration was also associated with higher odds of being offered and accepting follow-up. Higher suicidal desire uniquely increased the odds of offers, whereas a higher level of buffers uniquely decreased the odds of offers. Limitations: Data were collected from a single 988-member center and cannot be generalized. Conclusions: That one-third of callers do not accept follow-up highlights the need to understand reasons for not accepting follow-up. That callers with higher risk profiles are offered and accept follow-up at higher rates is reassuring and underscores the benefit of tailoring follow-up interventions for higher-risk callers.
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Affiliation(s)
| | - Megan Doyle
- Graduate School of Social Work, University of Denver, CO, USA
| | - Stephen Miller
- Research and Evaluation Division, Didi Hirsch Mental Health Services, Culver City, CA, USA
| | - Sae Lee
- Research and Evaluation Division, Didi Hirsch Mental Health Services, Culver City, CA, USA
| | - Fred J Pasquarella
- Research and Evaluation Division, Didi Hirsch Mental Health Services, Culver City, CA, USA
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Han J, Slade A, Fujimoto H, Zheng WY, Shvetcov A, Hoon L, Funke Kupper J, Senadeera M, Gupta S, Venkatesh S, Mouzakis K, Gu Y, Bilgrami A, Saba N, Cutler H, Batterham P, Boydell K, Shand F, Whitton A, Christensen H. A web-based video messaging intervention for suicide prevention in men: study protocol for a five-armed randomised controlled trial. Trials 2024; 25:466. [PMID: 38982443 PMCID: PMC11234748 DOI: 10.1186/s13063-024-08308-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 07/01/2024] [Indexed: 07/11/2024] Open
Abstract
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.
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Affiliation(s)
- Jin Han
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
- Centre for Global Health Equity, New York University Shanghai, Shanghai, China
| | - Aimy Slade
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Hiroko Fujimoto
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Wu Yi Zheng
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Artur Shvetcov
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Leonard Hoon
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, VIC, Australia
| | - Joost Funke Kupper
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, VIC, Australia
| | - Manisha Senadeera
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, VIC, Australia
| | - Sunil Gupta
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, VIC, Australia
| | - Svetha Venkatesh
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, VIC, Australia
| | - Kon Mouzakis
- Applied Artificial Intelligence Institute, Deakin University, Melbourne, VIC, Australia
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Anam Bilgrami
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Noura Saba
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Philip Batterham
- Centre for Mental Health Research, Australia National University, Canberra, ACT, Australia
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Alexis Whitton
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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Choi NG, Marti CN, Choi BY. Mental Health Treatment Use, Perceived Treatment Need, and Reasons for Non-Use Among U.S. Adults with Serious Suicidal Thoughts During the COVID-19 Pandemic. Community Ment Health J 2024; 60:972-984. [PMID: 38372825 DOI: 10.1007/s10597-024-01249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
Analyzing the 2021 National Survey on Drug Use and Health data with generalized linear models, we examined: (1) COVID pandemic-related and other correlates of mental health treatment use and unmet perceived treatment need among U.S. adults who experienced serious suicidal thoughts (N = 3,177); and (2) correlates of self-reported reasons for not receiving treatment. We found that 61% used any mental health treatment, and 48% of users and 37% of nonusers reported perceived treatment need. Significant correlates of treatment use were demographic factors, insurance, major depressive disorder, and illicit drug use disorder. Significant correlates of perceived treatment need were age 18-34, some college education, and major depressive episode. Perceived negative effect of the COVID pandemic on mental health was a significant factor for both treatment use and perceived need. The most frequent reasons for not getting treatment were the cost of treatment or lack of insurance and stigma-related concerns.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Philadelphia, USA
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Sheldon E, Ezaydi N, Desoysa L, Young J, Simmonds-Buckley M, Hind PD, Burton PC. Barriers to help-seeking, accessing and providing mental health support for medical students: a mixed methods study using the candidacy framework. BMC Health Serv Res 2024; 24:738. [PMID: 38877493 PMCID: PMC11179297 DOI: 10.1186/s12913-024-11204-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/13/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The mental health of medical students is a national and international problem increasing in both demand and acuity. Medical students face barriers to accessing mental health support that is clinically effective, timely and appropriate for their needs. This mixed methods study aimed to explore experiences of these barriers and the challenges to health service delivery aligned to the Candidacy Framework. METHODS One hundred three medical students studying at The University of Sheffield completed an online survey comprising the CCAPS-34 and follow-up questions about service access and use. Semi-structured interviews with a nested sample of 20 medical students and 10 healthcare professionals explored barriers to service access and provision. A stakeholder panel of medical students and professionals met quarterly to co-produce research materials, interpret research data and identify touchpoints by pinpointing specific areas and moments of interaction between a medical student as a service user and a mental health service. RESULTS Medical students who experienced barriers to help-seeking and accessing support scored significantly higher for psychological symptoms on the CCAPS-34. Uncertainty and fear of fitness to practice processes were important barriers present across all seven stages of candidacy. The fragmented structure of local services, along with individual factors such as perceived stigma and confidentiality concerns, limited the progression of medical students through the Candidacy Framework (a framework for understanding the different stages of a person's journey to healthcare). CONCLUSION This study outlines important areas of consideration for mental health service provision and policy development to improve access to and the quality of care for medical students.
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Affiliation(s)
- Elena Sheldon
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
- Clinical Trials Research Unit, Sheffield Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Naseeb Ezaydi
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Lauren Desoysa
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Jasmine Young
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | | | - Prof Daniel Hind
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Prof Chris Burton
- Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
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6
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Murakami R, Kamikubo A, Morioka D, Kuroki H. Forensic analysis of suicide deaths: Comparing forensic information with public information and investigating factors contributing to psychiatric consultations. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e194. [PMID: 38868080 PMCID: PMC11114437 DOI: 10.1002/pcn5.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 06/14/2024]
Abstract
Aim This study aimed to examine the usefulness of forensic information on suicide deaths in Japan for epidemiological studies on suicide and determine the factors that lead people with suicidal ideation to seek psychiatric care prior to attempting suicide. Methods We focused on forensic information of 514 suicide deaths that occurred in Osaka City in 2019. First, to examine whether the data used in this study can be generalized to these cases, we compared the information on suicide deaths officially published by Osaka City with that used in this study, utilizing Pearson's χ 2 test. Next, the forensic data were analyzed using multivariate logistic regression analysis to confirm the relationship between demographic factors and the likelihood of having a history of psychiatric consultation before suicide. Results Both the official information and the data used in this study showed a higher number of males than females who died by suicide, with no significant differences in values between the data sets. Multivariate logistic regression analysis showed significant correlations. More females were associated with seeking a psychiatric consultation. However, those with regular jobs or students were more likely to avoid a psychiatric consultation. Conclusion The findings of this study provide insights into the phenomenon of suicide deaths by using a forensic perspective. The results of this study suggest that psychiatric consultation may be effective in reducing deaths by suicide. Forensic data should be incorporated into the formulation of suicide-prevention policies in Japan to conduct a more multifaceted analysis and improve suicide-prevention measures.
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Affiliation(s)
- Ryu Murakami
- Faculty of Emergency Medical ScienceMeiji University of Integrative MedicineNantanKyotoJapan
- Graduate School of Risk and Crisis ManagementChiba Institute of ScienceChibaJapan
| | - Atsushi Kamikubo
- Faculty of Emergency Medical ScienceMeiji University of Integrative MedicineNantanKyotoJapan
- Osaka Prefectural Medical Examiner's OfficeOsakaJapan
| | - Daigo Morioka
- Faculty of Emergency Medical ScienceMeiji University of Integrative MedicineNantanKyotoJapan
| | - Hisanaga Kuroki
- Graduate School of Risk and Crisis ManagementChiba Institute of ScienceChibaJapan
- Osaka Prefectural Medical Examiner's OfficeOsakaJapan
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7
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Reily NM, Tang S, Batterham PJ, Aadam B, Draper B, Shand F, Han J, Nicholas A, Christensen H. Help-Seeking and Barriers to Service Use amongst Men with Past-Year Suicidal Ideation and not in Contact with Mental Health Services. Arch Suicide Res 2024; 28:482-498. [PMID: 36987997 DOI: 10.1080/13811118.2023.2190781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Men are less likely than women to engage with formal mental health services for suicidality. We describe the sources of support, barriers to service use, and coping strategies of men with past-year suicidal ideation who are not receiving formal mental health services. METHOD Australian men experiencing past-year suicidal ideation who also did not receive formal mental health services within the past year (n = 176) completed a survey that assessed help-seeking behaviors, coping strategies and styles, use of general services, barriers to service use, and individual-level characteristics. Analyses included descriptive statistics and bivariate analyses. RESULTS The most common type of support was self-help resources, and self-reliance was the most common barrier to formal mental health service use. Most participants had seen a GP for non-mental-health-related reasons in the past year. Men who did not seek any help for their suicidality experienced lower instrumental barriers and perceived need for support, and lower levels of certain coping styles. Limitations included a cross-sectional design and small sample size. CONCLUSION The current study provides insight into the help-seeking experiences of men with past-year suicidality and not receiving formal mental health services. The findings suggest it may be helpful to improve the linkage between online and informal sources of support and evidence-based interventions.
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8
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Choi NG, Marti CN, Choi BY. Suicide from intimate partner and other relationship conflicts: demographic and clinical correlates'. J Ment Health 2024; 33:84-91. [PMID: 37578139 DOI: 10.1080/09638237.2023.2245886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND A significant portion of suicides are precipitated by interpersonal relationship problems. AIMS To examine demographic and clinical correlates of any intimate partner conflicts (IPC) and other interpersonal conflicts (OPC) as suicide precipitants. METHODS We analyzed data on 92,805 (72,628 male; 20,177 female) adult suicide decedents from the 2017 to 2019 U.S. National Violent Death Reporting System, using multinomial and binary logistic regression models. We included case examples from coroners/medical examiner (CME) and law enforcement (LE) agency reports. RESULTS Of all decedents, 23.6% had IPC and 8.0% had OPC as a suicide precipitant. Compared to those without any relationship conflict, those who had IPC or OPC were younger and more likely to have had previous suicide attempt(s), alcohol/other substance use problems, and job/finance/housing and legal problems. Compared to those with OPC, those with IPC were more likely to be male and Hispanic and had higher odds of previous suicide attempt, depression diagnosis, alcohol problems, and more acute crises. CME/LE reports showed distress of divorce/break-up, other life stressors, prior suicide attempt(s), alcohol/other substance involvement, and/or loss of family support. CONCLUSIONS Access to behavioral health treatment for those at risk of suicide in the face of IPC or OPC is essential for suicide prevention.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
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Truong M, Dwyer J, Chan J, Bugeja L. Availability and quality of data related to cultural and linguistic diversity in the Victorian Suicide Register: A pilot study. Aust N Z J Public Health 2023; 47:100078. [PMID: 37586128 DOI: 10.1016/j.anzjph.2023.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 03/29/2023] [Accepted: 07/16/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE While people from culturally and linguistically diverse (CALD) backgrounds have been identified as a priority for suicide prevention in Australia, little is known about suicide in CALD communities. We aim to describe the availability and quality of CALD data in the Victorian Suicide Register (VSR). METHODS A retrospective consecutive case series review of suicides reported to the Coroners Court of Victoria during 2016 was conducted. Using the VSR, we identify suicides showing evidence of CALD identity and relevant variables were extracted and coded according to an adapted Australian Institute of Health and Welfare framework. RESULTS During 2016, 126 of 652 suicides (19.3%, 95% confidence intervals 16.4-22.6) were flagged as showing evidence of CALD. The two most frequent CALD indicators for which information was recorded were country of birth and year of arrival. There was less information pertaining to citizenship, residency/visa status, preferred language, English language proficiency and religious affiliation. CONCLUSIONS This study demonstrates that the VSR, like other databases, has substantial gaps in availability and quality of CALD data. IMPLICATIONS A framework to capture richer data on cultural, religious and linguistic diversity when coding suicides is needed to inform policy on suicide prevention initiatives designed for CALD communities.
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Affiliation(s)
- Mandy Truong
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia.
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Southbank, Victoria, Australia
| | - Jocelyn Chan
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Chitty KM, Sperandei S, Carter GL, Ali Z, Raubenheimer JE, Schaffer AL, Page A, Buckley NA. Five healthcare trajectories in the year before suicide and what they tell us about opportunities for prevention: a population-level case series study. EClinicalMedicine 2023; 63:102165. [PMID: 37649805 PMCID: PMC10462847 DOI: 10.1016/j.eclinm.2023.102165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/16/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
Background Suicide prevention requires a shift from relying on an at-risk individual to engage with the healthcare system. Understanding patterns of healthcare engagement by people who have died by suicide may provide alternative directions for suicide prevention. Methods This is a population-based case-series study of all suicide decedents (n = 3895) in New South Wales (NSW), Australia (2013-2019), with linked coronial, health services and medicine dispensing data. Healthcare trajectories were identified using a k-means longitudinal 3d analysis, based on the number and type of healthcare contacts in the year before death. Characteristics of each trajectory were described. Findings Five trajectories of healthcare utilisation were identified: (A) none or low (n = 2598, 66.7%), (B) moderate, predominantly for physical health (n = 601, 15.4%), (C) moderate, with high mental health medicine use (n = 397, 10.2%), (D) high, predominantly for physical health (n = 206, 5.3%) and E) high, predominantly for mental health (n = 93, 2.4%). Given that most decedents belonged to Trajectory A this suggests a great need for suicide preventive interventions delivered in the community, workplace, schools or online. Trajectories B and D might benefit from opioid dispensing limits and access to psychological pain management. Trajectory C had high mental health medicine use, indicating that the time that medicines are prescribed or dispensed are important touchpoints. Trajectory E had high mental health service predominantly delivered by psychiatrists and community mental health, but limited psychologist use. Interpretation Although most suicide decedents made at least one healthcare contact in the year before death, contact frequency was overall very low. Given the characteristics of this group, useful access points for such intervention could be delivered through schools and workplaces, with a focus on alcohol and drug intervention alongide suicide awareness. Funding Australia's National Health and Medical Research Council.
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Affiliation(s)
- Kate M. Chitty
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- School of Population and Global Health, Faculty of Health and Medicine, University of Western Australia, WA, Australia
| | - Sandro Sperandei
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Gregory L. Carter
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Zein Ali
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Jacques E. Raubenheimer
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Andrea L. Schaffer
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- School of Population Health, University of New South Wales, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Nicholas A. Buckley
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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van der Burgt MCA, Mérelle S, Brinkman WP, Beekman ATF, Gilissen R. Breaking Down Barriers to a Suicide Prevention Helpline: Protocol for a Web-Based Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41078. [PMID: 37093641 PMCID: PMC10167578 DOI: 10.2196/41078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Globally, suicide is among the leading causes of death, with men being more at risk to die from suicide than women. Research suggests that people with suicidal ideation often struggle to find adequate help. Every month, around 4000 people fill in the anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. This self-test includes the Suicidal Ideation Attributes Scale (SIDAS), which educates users about the severity of their suicidal thoughts. The vast majority (70%) of people who complete the self-test score higher than the cutoff point (≥21) for severe suicidal thoughts. Unfortunately, despite this, less than 10% of test-takers navigate to the web page about contacting the helpline. OBJECTIVE This protocol presents the design of a web-based randomized controlled trial that aims to reduce barriers to contacting the suicide prevention helpline. The aim of this study is 2-fold: (1) to measure the effectiveness of a brief barrier reduction intervention (BRI) provided in the self-test motivating people with severe suicidal thoughts to contact the Dutch suicide prevention helpline and (2) to specifically evaluate the effectiveness of the BRI in increasing service use by high-risk groups for suicide such as men and middle-aged people. METHODS People visiting the self-test for suicidal thoughts on the website of the suicide prevention helpline will be asked to participate in a study to improve the self-test. Individuals with severe suicidal thoughts and little motivation to contact the helpline will be randomly allocated either to a brief BRI, in which they will receive a short tailored message based on their self-reported barrier to the helpline (n=388) or care as usual (general advisory text, n=388). The primary outcome measure is the use of a direct link to contact the helpline after receiving the intervention or control condition. Secondary outcomes are the self-reported likelihood of contacting the helpline (on a 5-point scale) and satisfaction with the self-test. In the BRI, participants receive tailored information to address underlying concerns and misconceptions of barriers to the helpline. A pilot study was conducted among current test-takers to identify these specific barriers. RESULTS The pilot study (N=1083) revealed multiple barriers to contacting the helpline. The most prominent were the belief that a conversation with a counselor would not be effective, fear of the conversation itself, and emotional concerns about talking about suicidal thoughts. CONCLUSIONS Our study will provide insight into the effectiveness of a brief BRI designed to increase the use of a suicide prevention helpline provided in a self-test on suicidal thoughts. If successful, this intervention has the potential to be a low-cost, easily scalable, and feasible method to increase service use for helplines across the world. TRIAL REGISTRATION ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/ct2/show/NCT05458830. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/41078.
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Affiliation(s)
- Margot C A van der Burgt
- Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Saskia Mérelle
- Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Willem-Paul Brinkman
- Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Renske Gilissen
- Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands
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Encina-Zúñiga E, Agrest M, Tapia-Munoz T, Vidal-Zamora I, Ardila-Gómez S, Alvarado R, Leiderman EA, Reavley N. Development of mental health first-aid guidelines for depression: a Delphi expert consensus study in Argentina and Chile. BMC Psychiatry 2023; 23:161. [PMID: 36918853 PMCID: PMC10013290 DOI: 10.1186/s12888-023-04661-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. METHODS A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. RESULTS Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. CONCLUSIONS The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.
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Affiliation(s)
- Esteban Encina-Zúñiga
- grid.443909.30000 0004 0385 4466School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- grid.443909.30000 0004 0385 4466Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Martín Agrest
- Proyecto Suma, Güemes 4130 (1425), Ciudad Autónoma de Buenos Aires, Argentina
| | - Thamara Tapia-Munoz
- grid.83440.3b0000000121901201Department of Behavioural Science and Health, University College London, London, UK
| | - Isidora Vidal-Zamora
- grid.443909.30000 0004 0385 4466Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sara Ardila-Gómez
- grid.7345.50000 0001 0056 1981Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina
- grid.423606.50000 0001 1945 2152Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Buenos Aires, Argentina
| | - Rubén Alvarado
- grid.443909.30000 0004 0385 4466School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- grid.412185.b0000 0000 8912 4050Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Eduardo A. Leiderman
- grid.441624.10000 0001 1954 9157Departamento de Neurociencias, Facultad de Ciencias Sociales, Universidad de Palermo, Buenos Aires, Argentina
| | - Nicola Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
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Tang S, Reily NM, Batterham PJ, Draper B, Shand F, Han J, Aadam B, Christensen H. Correlates of non-receipt of formal mental health services among Australian men experiencing thoughts of suicide. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Eskin M, Baydar N. Do neoliberal values provide a fertile soil for suicidal ideation? J Affect Disord 2022; 314:349-356. [PMID: 35872247 DOI: 10.1016/j.jad.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/28/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Values associated with neoliberal ideologies are blamed for damaging the social fabric. They may also have deleterious effects on suicidal ideation. OBJECTIVE We investigated whether neoliberal values were associated with the risk for suicidal ideation through a set of mediating factors (suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability). METHODS A total of 508 (249 female) adults from the U.S. responded to a self-administered questionnaire that contained measures of suicidal ideation, neoliberal values, suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability. We tested a path model that linked neoliberal values to suicidal ideation through multiple mediators. We tested total versus partial mediation models. RESULTS We found empirical evidence for a full mediation of the association of neoliberal values with perceived stress. Neoliberal values were associated with suicide stigma; suicide stigma was associated with negative attitudes towards help-seeking, which, in turn, were associated with high levels of perceived stress. The association of neoliberal values with suicide acceptability was partially mediated. Perceived stress was positively associated with suicide risk directly and indirectly through suicide acceptability. CONCLUSION Our findings suggest that values related to neoliberal ideologies prepare a context that fosters the risk for suicide. For a contextualized understanding of suicidal behavior, more research is needed that explores the role of social, cultural, political, and economic ideologies in the suicidal process.
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Affiliation(s)
- Mehmet Eskin
- Koc University, College of Social Sciences and Humanities, Department of Psychology, Istanbul, Turkey(1).
| | - Nazli Baydar
- Koc University, College of Social Sciences and Humanities, Department of Psychology, Istanbul, Turkey(1)
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Li F, Gu L, Xu H. The Mining Method of Ideological and Political Elements in University Public Mental Health Courses Based on Artificial Intelligence Technology. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:2829974. [PMID: 36089948 PMCID: PMC9451957 DOI: 10.1155/2022/2829974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 11/18/2022]
Abstract
Artificial intelligence technology has become an important part of the development of Internet technology. Artificial intelligence technology can help colleges and universities optimize the network ideological and political teaching system. Artificial intelligence technology provides more accurate data resources and rich and reliable educational technology means for online public mental health education in colleges and universities. This paper comprehensively uses a variety of methods such as qualitative and quantitative analysis, case and empirical analysis, literature analysis, and artificial intelligence technology. Artificial intelligence technology has been closely integrated with online public mental health education in colleges and universities. The model systematically analyzes the optimization methods of artificial intelligence technology methods for the online public mental health education system in colleges and universities, and constructs an innovation system for online public mental health education in colleges and universities. Based on the comprehensive analysis of artificial intelligence and public health in colleges and universities, this paper further proposes the application of artificial intelligence technology in online public mental health education in colleges and universities. On this basis, the model conducts an in-depth analysis of artificial intelligence technology and the online public mental health innovation system. The model supports the development of ideological and political teaching in colleges and universities through various forms such as idea innovation, path innovation, carrier innovation, and mechanism innovation.
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Affiliation(s)
- Fangfang Li
- Student Affairs Office, Hebei Normal University of Science & Technology, Qinhuangdao, Hebei 066000, China
| | - Le Gu
- Student Affairs Office, Hebei Normal University of Science & Technology, Qinhuangdao, Hebei 066000, China
| | - Hongchao Xu
- College of Physical Education and Health, Hebei Normal University of Science & Technology, Qinhuangdao, Hebei 066000, China
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