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King KE, Liddle SK, Nicholas A. A qualitative analysis of self-reported suicide gatekeeper competencies and behaviour within the Australian construction industry. Health Promot J Austr 2024; 35:760-769. [PMID: 37793646 DOI: 10.1002/hpja.815] [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: 04/14/2023] [Revised: 09/04/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
ISSUE ADDRESSED Construction workers in Australia have suicide rates 84% higher than other workers, with even higher rates for younger and less-skilled workers. Gatekeeper training (GKT) is a suicide prevention strategy that aims to improve knowledge, attitudes and self-efficacy to identify and assist individuals at risk of suicide. However, the impact of GKT on long-term behaviour and suicide prevention is unclear in the construction industry. METHODS Researchers conducted 22 semi-structured interviews with trained Bluehats, who provide support to their colleagues in the construction industry experiencing mental health difficulties and suicidal distress. RESULTS Participants reported high levels of motivation and capability due to lived experience of mental health problems or suicide, training, satisfaction from helping others and feeling valued in their work environment. CONCLUSIONS The study highlighted the importance of physical and social opportunities for participants to support their colleagues. The findings reinforced the need to integrate GKT within comprehensive industry suicide prevention programs that provide a range of interventions for workers and ongoing support to trainees to translate their skills into behaviour. Future GKT should include behaviour change approaches to identify and target contextual and individual-level factors influencing behaviour. SO WHAT?: Understanding the potential and limitations of GKT within the construction industry offers invaluable insights for health promotion. Integrating GKT with holistic prevention programs could lead to more impactful strategies, potentially reducing the high suicide rates and fostering a healthier work environment in the construction sector.
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Affiliation(s)
- Kylie E King
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sarah K Liddle
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Angela Nicholas
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Kingi-Uluave D, Taufa N, Tuesday R, Cargo T, Stasiak K, Merry S, Hetrick S. A Review of Systematic Reviews: Gatekeeper Training for Suicide Prevention with a Focus on Effectiveness and Findings. Arch Suicide Res 2024:1-18. [PMID: 38884349 DOI: 10.1080/13811118.2024.2358411] [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] [Indexed: 06/18/2024]
Abstract
OBJECTIVES Suicide prevention gatekeeper training (GKT) is considered an important component of an overall suicide-prevention strategy. The primary aim of this study was to conduct the first robust review of systematic reviews of GKT to examine the overall effectiveness of GKT on knowledge, self-efficacy, attitudes, behavioral intentions, and behavioral change. The study also examined the extent to which outcomes were retained long term, the frequency of refresher sessions, and the effectiveness of GKT with Indigenous populations and e-learning delivery. METHODS For this review of reviews, MEDLINE, PsycINFO, Embase; and the Cochrane Database of Systematic Reviews were searched. ROBIS was applied to assess risk of bias and findings were synthesized using narrative synthesis. RESULTS Six systematic reviews were included comprising 61 studies, of which only 10 were randomized controlled trials (RCTs). Immediate positive effects of GKT on knowledge, skills, and self-efficacy were confirmed, including for interventions tailored for Indigenous communities. Evidence was mixed for change in attitude; few studies measured e-learning GKT, retention of outcomes, booster sessions, behavioral intentions, and behavioral change, with some positive results. CONCLUSIONS Evidence supports the immediate effects of GKT but highlights a need for more high-quality RCTs, particularly for Indigenous and e-learning GKT. This review identified a concerning lack of long-term follow-up assessments at multiple time points, which could capture behavioral change and a significant gap in studies focused on post-training interventions that maintain GKT effects over time.
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Hu FH, Jia YJ, Zhao DY, Fu XL, Zhang WQ, Tang W, Hu SQ, Wu H, Ge MW, Du W, Shen WQ, Chen HL. Gender differences in suicide among patients with bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2023; 339:601-614. [PMID: 37467799 DOI: 10.1016/j.jad.2023.07.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To examine gender differences in suicidal ideation, suicide attempts, and suicide deaths in patients with bipolar disorder. METHODS PubMed, Web of Science, and Embase were systematic searched from inception to March 7, 2023. Two reviewers extract data independently. Demographic data, the number of males and females with bipolar disorder, and the number of individuals with suicidal ideation, suicide attempts, and suicide deaths among participants were extracted. RESULTS The pooled prevalence of suicidal ideation in males and females was 48.0 % and 44.0 %, respectively, and the overall male-to-female ratios present a statistically insignificant result (OR = 0.95, 95%CI = 0.75-1.21) among patients with bipolar disorder. The pooled prevalence of suicide attempts in males and females was 6.7 % and 9.3 %, respectively, and there was a statistically significant lower prevalence among male patients with bipolar disorder (OR = 0.71, 95%CI = 0.67-0.75). However, the pooled prevalence of suicide deaths in males and females was 0.7 % and 0.3 % respectively, and there was a statistically significant higher prevalence among male patients with bipolar disorder (OR = 1.86, 95%CI = 1.63-2.13). LIMITATIONS The included studies were from mainly middle- and high-income countries and used inconsistent measurement tools. Thus, there is a potential for bias in our results. CONCLUSIONS Among patients with bipolar disorder, females were found to have a higher prevalence of suicide attempts, while males have a higher prevalence of suicide deaths. However, there is no significant gender difference in suicidal ideation. Efforts to optimize recognition, treatment, and administration in males and females may reduce gender differences.
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Affiliation(s)
- Fei-Hong Hu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Yi-Jie Jia
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Dan-Yan Zhao
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Xue-Lei Fu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Shi-Qi Hu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Hua Wu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, PR China.
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Norrod PE, Sanderson WT, Abner EL, Seals J, Browning S. Farmer Suicides Among States Reporting Violent Deaths, 2003 - 2017. RURAL MENTAL HEALTH 2023; 47:139-151. [PMID: 37449301 PMCID: PMC10336572 DOI: 10.1037/rmh0000232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Research suggests that farmer suicide rates are at least two-fold higher than the general population. In estimating rates, prior research considered suicide events among farmers together with farmworkers, fishing, and forestry occupations and included non-farming populations in the defined at-risk populations (i.e., denominators). In this study, we sought to define and differentiate farmer suicide decedents from other agricultural occupations, estimate U.S. farmer suicide rates, and evaluate rate time trends. Farmer suicide decedents were ascertained from the 36 states in the National Violent Death Reporting System (NVDRS) from 2003-2017 using NVDRS occupation data. Farmers were defined as persons responsible for day-to-day farm decisions and operations. An expert panel was convened to classify farmer occupations. Rates were calculated using Census of Agriculture-identified farmers as the rate denominator, and time trends were evaluated using regression. Due to a low number of female decedents, female farmer suicide rates were not estimated. We identified1,575 male farmer suicide decedents and 77 female farmer decedents from the NVDRS during the study period. Aggregated age-specific male farmer suicide rates were highest among farmers ages 65 years and older (22.0/100,000). Estimated suicide rates for male farmers were highest during 2003 (31.8/100,000) and lowest during 2005 (19.2/100,000). Trend analysis revealed a statistically significant 2.4% annual percent change (APC) in rates over the 15-year study period. Suicide rates among male farmers showed evidence of an increase from 2003-2017. Farmer suicide rates parallel the rates of the U.S. population; thus, farmer suicide remains a public health concern.
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Affiliation(s)
- Paul E. Norrod
- Family and Consumer Sciences Extension, University of Kentucky
| | - Wayne T. Sanderson
- Department of Biosystems and Agricultural Engineering University of Kentucky
| | - Erin L. Abner
- Department of Epidemiology and Environmental Health, University of Kentucky
| | - Jacqueline Seals
- Department of Epidemiology and Environmental Health, University of Kentucky
| | - Steve Browning
- Department of Epidemiology and Environmental Health, University of Kentucky
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Allie SLN, Bantjes J, Andriessen K. Suicide postvention for staff and students on university campuses: a scoping review. BMJ Open 2023; 13:e068730. [PMID: 37328183 PMCID: PMC10277115 DOI: 10.1136/bmjopen-2022-068730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE To examine current knowledge about suicide bereavement and postvention interventions for university staff and students. DESIGN Scoping review. DATA SOURCES AND ELIGIBILITY We conducted systematic searches in 12 electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, Africa-Wide Information, PsycARTICLES, Health Source: Nursing/Academic Edition, Academic Search Premier, SocINDEX through the EBSCOHOST platform; Cochrane Library, Web of Science, SCOPUS), hand searched lists of references of included articles and consulted with library experts during September 2021 and June 2022. Eligible studies were screened against the inclusion criteria independently by two reviewers. Only studies published in English were included. DATA EXTRACTION AND SYNTHESIS Screening was conducted by two independent reviewers following a three-step article screening process. Biographical data and study characteristics were extracted using a data extraction form and synthesised. RESULTS Our search strategy identified 7691 records from which 3170 abstracts were screened. We assessed 29 full texts and included 17 articles for the scoping review. All studies were from high-income countries (USA, Canada, UK). The review identified no postvention intervention studies on university campuses. Study designs were mostly descriptive quantitative or mixed methods. Data collection and sampling were heterogeneous. CONCLUSION Staff and students require support measures due to the impact of suicide bereavement and the unique nature of the university context. There is a need for further research to move from descriptive studies to focus on intervention studies, particularly at universities in low-income and middle-income countries.
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Affiliation(s)
| | - Jason Bantjes
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU), South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Lawrence DM, Sheil B. Advancing our knowledge of people who die by suicide in order to improve suicide prevention. Med J Aust 2023. [PMID: 37321601 DOI: 10.5694/mja2.52011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
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Puig-Amores I, Cuadrado-Gordillo I, Martín-Mora-Parra G. Health Service Protection vis-à-vis the Detection of Psychosocial Risks of Suicide during the Years 2019-2021. Healthcare (Basel) 2023; 11:healthcare11101505. [PMID: 37239791 DOI: 10.3390/healthcare11101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023] Open
Abstract
Health services are especially relevant in suicide prevention and intervention, representing a favourable environment in which to implement specific strategies to detect and address suicidal behaviours. Indeed, a significant proportion of people who die by suicide (DBS) present at primary care and mental health services during the last year, month, or even days before committing suicide. The objective of this descriptive and cross-sectional study of all registered cases of death by suicide (N = 265) in Extremadura (Spain) was to determine which of those people who died by suicide had mental health problems (MHP) and what type of assistance they had requested. Diagnoses, previous suicide attempts, type of health service, and last visit before death were explored with univariate analyses and logistic regressions. The proportion of people without MHP was found to be high, and these people had hardly visited the health services at all in their last year. People with MHP, between the ages of 40 and 69, and with previous suicide attempts were more likely to have visited the mental health service in the three months prior to their death. It is, thus, necessary to provide health professionals with tools and training in the prevention of and approach to suicide. Efforts must be directed towards effectively assessing mental health and the risk of suicide since a large proportion of people who die by suicide may go unnoticed.
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Affiliation(s)
- Ismael Puig-Amores
- Department of Psychology and Anthropology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain
| | - Isabel Cuadrado-Gordillo
- Department of Psychology and Anthropology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain
| | - Guadalupe Martín-Mora-Parra
- Department of Psychology and Anthropology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain
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Altavini CS, Asciutti APR, Santana GL, Solis ACO, Andrade LH, Oliveira LG, Andrade AG, Gorenstein C, Wang YP. Suicide ideation among Brazilian college students: Relationship with academic factors, mental health, and sexual abuse. J Affect Disord 2023; 329:324-334. [PMID: 36849006 DOI: 10.1016/j.jad.2023.02.112] [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: 06/14/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Suicide is one of the leading causes of death among youth and its occurrence among college students is a matter of great concern. Challenges of transitional adulting and mental illness increase the likelihood of suicidal cognition in students. The objective of present study was to investigate the prevalence of suicide ideation and associated factors in a representative sample of Brazilian college students (n = 12,245). METHODS Data were drawn from a nationwide survey and further subjected to estimate the prevalence of suicide ideation and its association with socio-demographic and academic characteristics. We performed logistic regression analyses upon a conceptual framework, considering individual and academic factors. RESULTS The point-prevalence of suicide ideation among college students was 5.9 % (SE = 0.37). In the final regression model, variables associated with the likelihood of suicide ideation were psychopathology, sexual abuse, and academic variables, such as dissatisfaction with the chosen undergraduate course (OR = 1.86; IC95 % 1.43-2.41) and low academic performance (OR = 3.56; IC95 % 1.69-7.48). Having children and religious affiliation were inversely associated with the likelihood of suicide ideation. LIMITATIONS Participants were recruited from state capitals, which limited data generalizability to non-urban college students. CONCLUSIONS The impact of academic life on the mental health of students should be carefully monitored in in-campus pedagogical and health services. Early identification of poor-performance students with social disadvantages could indicate vulnerable ones who are much in need of psycho-social support.
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Affiliation(s)
- Camila Siebert Altavini
- Instituto & Departamento de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Centro de Atendimento e Estudos Psicológicos, Instituto de Psicologia, Universidade de Brasilia, Brasilia, DF, Brazil
| | - Antônio Paulo Rinaldi Asciutti
- Instituto & Departamento de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Geilson Lima Santana
- Instituto & Departamento de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Cristina Oliveira Solis
- Instituto & Departamento de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Laura Helena Andrade
- Instituto & Departamento de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Arthur Guerra Andrade
- Instituto & Departamento de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Faculdade de Medicina, Fundacao do ABC, Santo Andre, SP, Brazil
| | - Clarice Gorenstein
- Instituto & Departamento de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto de Ciencias Biomedicas, Universidade Sao Paulo, Sao Paulo, SP, Brazil
| | - Yuan-Pang Wang
- Instituto & Departamento de Psiquiatria (LIM-23), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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9
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Griffiths JJ, Zarate CA, Rasimas JJ. Existing and Novel Biological Therapeutics in Suicide Prevention. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:225-232. [PMID: 37201148 PMCID: PMC10172549 DOI: 10.1176/appi.focus.23021003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We summarize outcomes for several pharmacologic and neurostimulatory approaches that have been considered potential treatments to reduce suicide risk, namely, by reducing suicide deaths, attempts, and ideation in various clinical populations. Available treatments include clozapine, lithium, antidepressants, antipsychotics, electroconvulsive therapy, and transcranial magnetic stimulation. The novel repurposing of ketamine as a potential suicide risk-mitigating agent in the acute setting is also discussed. Research pathways to better understand and treat suicidal ideation and behavior from a neurobiological perspective are proposed in light of this foundation of information and the limitations and challenges inherent in suicide research. Such pathways include trials of fast-acting medications, registry approaches to identify appropriate patients for trials, identification of biomarkers, neuropsychological vulnerabilities, and endophenotypes through the study of known suicide risk-mitigating agents in hope of determining mechanisms of pathophysiology and the action of protective biological interventions. Reprinted from Am J Prev Med 2014; 47:S195-S203, with permission from Elsevier. Copyright © 2014.
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Affiliation(s)
- Joshua J Griffiths
- From the Department of Psychiatry (Griffiths), University of Colorado, Denver, Colorado; Experimental Therapeutics and Pathophysiology Branch (Zarate, Rasimas), Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland; and Departments of Psychiatry and Emergency Medicine (Rasimas), Penn State College of Medicine, Hershey, Pennsylvania
| | - Carlos A Zarate
- From the Department of Psychiatry (Griffiths), University of Colorado, Denver, Colorado; Experimental Therapeutics and Pathophysiology Branch (Zarate, Rasimas), Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland; and Departments of Psychiatry and Emergency Medicine (Rasimas), Penn State College of Medicine, Hershey, Pennsylvania
| | - J J Rasimas
- From the Department of Psychiatry (Griffiths), University of Colorado, Denver, Colorado; Experimental Therapeutics and Pathophysiology Branch (Zarate, Rasimas), Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland; and Departments of Psychiatry and Emergency Medicine (Rasimas), Penn State College of Medicine, Hershey, Pennsylvania
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Zandberg J, Waller R, Visoki E, Barzilay R. Association Between State-Level Access to Reproductive Care and Suicide Rates Among Women of Reproductive Age in the United States. JAMA Psychiatry 2023; 80:127-134. [PMID: 36576746 PMCID: PMC9857811 DOI: 10.1001/jamapsychiatry.2022.4394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/07/2022] [Indexed: 12/29/2022]
Abstract
Importance Many states in the United States enforce restrictions to reproductive care, with access to abortion remaining a highly divisive issue. Denial of abortion is linked with heightened stress and anxiety among reproductive-aged women. However, no studies have tested whether access to reproductive care is linked to suicide. Objective To evaluate whether state-level restrictions in access to reproductive care in the United States were associated with suicide rates among reproductive-aged women from 1974 to 2016. Design, Setting, and Participants A longitudinal ecologic study with a difference-in-differences analysis assessed whether annual changes in the enforcement of state-level restrictions to reproductive care were related to annual state-level suicide rates vs rates of death due to motor vehicle crashes. Duration of follow-up varied between different states (range, 4-40 years), contingent on the first year that restrictions were implemented. Models controlled for year and state fixed effects and other relevant demographic and economic factors. Analyses were conducted between December 2021 and January 2022. Exposures Targeted Regulation of Abortion Providers (TRAP) laws index measuring state-year-level restrictions to reproductive care. Main Outcomes and Measures Annual state-level suicide rates and motor vehicle crash death rates among reproductive-aged women (ages 20-34 years; target group) vs women of postreproductive age (ages 45-64 years; control group). Results Twenty-one US states enforced at least 1 TRAP law between 1974 and 2016. Annual rates of death by suicide ranged from 1.4 to 25.6 per 100 000 women of reproductive age to 2.7 to 33.2 per 100 000 women of postreproductive age during the study period (1974-2016). Annual motor vehicle crash death rates among women of reproductive age ranged from 2.4 to 42.9 per 100 000. Enforcement of TRAP laws was associated with higher suicide rates among reproductive-aged women (β = 0.17; 95% CI, 0.03 to 0.32; P = .02) but not women of postreproductive age (β = 0.06; 95% CI, -0.11 to 0.24; P = .47) nor to deaths due to motor vehicle crashes (β = 0.03, 95% CI, -0.04 to 0.11; P = .36). Among reproductive-aged women, the weighted average annual-state level suicide death rate when no TRAP laws were enforced was 5.5 per 100 000. Enforcement of a TRAP law was associated with a 5.81% higher annual rate of suicide than in pre-enforcement years. Findings remained significant when using alternative, broader indices of reproductive care access and different age categorizations. Conclusions and Relevance In this study with a difference-in-differences analysis of US women, restrictions on access to reproductive care from 1974 to 2016 were associated with suicide rates among reproductive-aged women. Given the limitations of the ecologic design of this study, further research is needed to assess whether current factors affecting access to reproductive care services are related to suicide risk among women of reproductive age and to inform suicide prevention strategies.
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Affiliation(s)
| | - Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia
| | - Elina Visoki
- Children’s Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, Pennsylvania
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
| | - Ran Barzilay
- Children’s Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, Pennsylvania
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia
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11
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Fu XL, Qian Y, Jin XH, Yu HR, Wu H, Du L, Chen HL, Shi YQ. Suicide rates among people with serious mental illness: a systematic review and meta-analysis. Psychol Med 2023; 53:351-361. [PMID: 33952359 DOI: 10.1017/s0033291721001549] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND People with serious mental illness are at great risk of suicide, but little is known about the suicide rates among this population. We aimed to quantify the suicide rates among people with serious mental illness (bipolar disorder, major depression, or schizophrenia). METHODS PubMed and Web of Science were searched to identify studies published from 1 January 1975 to 10 December 2020. We assessed English-language studies for the suicide rates among people with serious mental illness. Random-effects meta-analysis was used. Changes in follow-up time and the suicide rates were presented by a locally weighted scatter-plot smoothing (LOESS) curve. Suicide rate ratio was estimated for assessments of difference in suicide rate by sex. RESULTS Of 5014 identified studies, 41 were included in this analysis. The pooled suicide rate was 312.8 per 100 000 person-years (95% CI 230.3-406.8). Europe was reported to have the highest pooled suicide rate of 335.2 per 100 000 person-years (95% CI 261.5-417.6). Major depression had the highest suicide rate of 534.3 per 100 000 person-years (95% CI 30.4-1448.7). There is a downward trend in suicide rate estimates over follow-up time. Excess risk of suicide in males was found [1.90 (95% CI 1.60-2.25)]. The most common suicide method was poisoning [21.9 per 100 000 person-years (95% CI 3.7-50.4)]. CONCLUSIONS The suicide rates among people with serious mental illness were high, highlighting the requirements for increasing psychological assessment and monitoring. Further study should focus on region and age differences in suicide among this population.
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Affiliation(s)
- Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Yan Qian
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Xiao-Hong Jin
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hai-Rong Yu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hua Wu
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Lin Du
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, 226019 PR China
| | - Ya-Qin Shi
- School of Medicine, Nantong University, Nantong, Jiangsu, 226001 PR China
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12
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Bareis N, Olfson M, Gerhard T, Rolin S, Stroup TS. Means of suicide among adults with schizophrenia across the life span. Schizophr Res 2023; 251:82-90. [PMID: 36592524 PMCID: PMC9872522 DOI: 10.1016/j.schres.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/26/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND HYPOTHESES Adults with schizophrenia have increased risk of suicide with highest risk among younger adults. We investigated whether means of suicide among these adults were different from the general population. STUDY DESIGN This retrospective longitudinal analysis used the National Death Index to characterize means of suicide among 4 cohorts of Medicare patients with schizophrenia (2007-2016) by age: 18 to 34, 35 to 44, 45 to 54, and aged 55+ years. Means of suicide were categorized by age at death and sex. Adjusted hazard ratios were calculated for common means. Mortality rates per 100,000 person-years were estimated by age group stratified by sex, and standardized to the general population by age, sex, and race-ethnicity using standardized mortality ratios. STUDY RESULTS 668,836 adults were included with 2218 suicide decedents: 1444 men and 774 women. The most common means of suicide was poisoning (36.8 %), with a significant sex difference by means: 55.9 % of women died by poisoning, 13.8 % by firearms, 11.0 % by hanging and 9.4 % by jumping, while among men suicide by poisoning (26.6 %), firearms (25.5 %), and hanging (24.2 %) were similar, followed by jumping (12.0 %). Suicide by poisoning among the schizophrenia cohort was 10 times that of the general population, while suicide by firearm was twice that of the general population. CONCLUSIONS Means of suicide differed for patients with schizophrenia compared to the general population: poisoning was the most common means among men and women with schizophrenia, while firearms accounted for over half of all suicides in the general U.S. POPULATION
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Affiliation(s)
- Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America.
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America; Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Tobias Gerhard
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States of America
| | - Stephanie Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, United States of America
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O'Rourke HP, Hilley CD, Lowell E, Sheehan CM. Sexual and gender identity and note-leaving among adult suicide decedents in the USA. BJPsych Open 2022; 9:e6. [PMID: 36539265 PMCID: PMC9798214 DOI: 10.1192/bjo.2022.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Suicide is one of the leading causes of preventable death in the USA, representing a critical public health threat. Suicide risks differ for different populations. In particular, the sexual and gender minority (SGM) population remains at increased risk for suicide. One of the circumstances that may differ for SGM and non-SGM individuals is the propensity to leave a suicide note. Information regarding note-leaving may be helpful in informing suicide prevention and intervention. AIMS This study documents the differences in note-leaving in SGM individuals compared with non-SGM individuals, using recent data from the National Violent Death Reporting System (N = 98 515) and accounting for important covariates. METHOD We fit a logistic regression model with SGM status and covariates predicting note-leaving in suicide. RESULTS SGM decedents were 1.508 times more likely to leave a note than their non-SGM counterparts, controlling for demographic, mental health and substance use covariates. CONCLUSIONS These findings highlight the importance of tailoring suicide prevention and intervention efforts to meet the needs of SGM populations.
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Affiliation(s)
- Holly P O'Rourke
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, USA
| | - Chanler D Hilley
- Department of Psychological Science, Kennesaw State University, USA
| | - Emily Lowell
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, USA
| | - Connor M Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, USA
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Schlichthorst M, Reifels L, Spittal M, Clapperton A, Scurrah K, Kolves K, Platt S, Pirkis J, Krysinska K. Evaluating the Effectiveness of Components of National Suicide Prevention Strategies. CRISIS 2022. [PMID: 36537610 DOI: 10.1027/0227-5910/a000887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: National suicide prevention strategies support development of suicide prevention activities and their evaluation. Aims: To describe components included in national suicide prevention strategies and analyze the potential contribution of individual components to reduce suicide rates. Method: We conducted a narrative review and statistical analysis of national suicide prevention strategies. The narrative review was based on a framework of 12 components and included 29 countries (14 lower middle-income countries [LMICs] and 15 high-income countries [HICs]) with a national suicide prevention strategy. The statistical analyses covered suicide mortality data for 24 countries with a national strategy (9 LMICs and 15 HICs). Results: The number of components adopted in national strategies ranged from 4 to 11, and training and education were included in 96.5% of strategies. Estimated period effects for total suicide rates in individual countries ranged from a significant decrease in the yearly suicide rate (RR = 0.80; 95% CI 0.69-0.93) to a significant increase (RR = 1.12; 95% CI 1.05-1.19). There were no changes in suicide mortality associated with individual components of national strategies. Limitations: The limitations of existing suicide mortality data apply to our study. Conclusion: Further detailed evaluations will help identify the specific contribution of individual components to the impact national strategies. Until then, countries should be encouraged to implement and evaluate comprehensive national suicide prevention strategies.
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Affiliation(s)
- Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Matthew Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Angela Clapperton
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Katrina Scurrah
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Kairi Kolves
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Boudreaux ED, Larkin C, Sefair AV, Mick E, Clements K, Pelletier L, Yang C, Kiefe C. Studying the implementation of Zero Suicide in a large health system: Challenges, adaptations, and lessons learned. Contemp Clin Trials Commun 2022; 30:100999. [PMID: 36237289 PMCID: PMC9551075 DOI: 10.1016/j.conctc.2022.100999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/12/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Suicide remains the 10th leading cause of death in the United States. Many patients presenting to healthcare settings with suicide risk are not identified and their risk mitigated during routine care. Our aim is to describe the planned methodology for studying the implementation of the Zero Suicide framework, a systems-based model designed to improve suicide risk detection and treatment, within a large healthcare system. Methods We planned to use a stepped wedge design to roll-out the Zero Suicide framework over 4 years with a total of 39 clinical units, spanning emergency department, inpatient, and outpatient settings, involving ∼310,000 patients. We used Lean, a widely adopted a continuous quality improvement (CQI) model, to implement improvements using a centralize "hub" working with smaller "spoke" teams comprising CQI personnel, unit managers, and frontline staff. Results Over the course of the study, five major disruptions impacted our research methods, including a change in The Joint Commission's safety standards for suicide risk mitigation yielding massive system-wide changes and the COVID-19 pandemic. What had been an ambitious program at onset became increasingly challenging because of the disruptions, requiring significant adaptations to our implementation approach and our study methods. Conclusions Real-life obstacles interfered markedly with our plans. While we were ultimately successful in implementing Zero Suicide, these obstacles led to adaptations to our approach and timeline and required substantial changes in our study methodology. Future studies of quality improvement efforts that cut across multiple units and settings within a given health system should avoid using a stepped-wedge design with randomization at the unit level if there is the potential for sentinel, system-wide events.
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Affiliation(s)
- Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Celine Larkin
- Departments of Emergency Medicine and Psychiatry, UMass Chan Medical School, Worcester, MA, USA
| | - Ana Vallejo Sefair
- Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Eric Mick
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Karen Clements
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | | | - Chengwu Yang
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Catarina Kiefe
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
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16
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Hafford-Letchfield T, Hanna JR, Ellmers TJ, Rasmussen S, Cogan N, Gleeson H, Goodman J, Martin S, Walker P, Quaife M. Talking really does matter: Lay perspectives from older people on talking about suicide in later life. Front Psychol 2022; 13:1009503. [PMID: 36467190 PMCID: PMC9709258 DOI: 10.3389/fpsyg.2022.1009503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/06/2022] [Indexed: 09/19/2023] Open
Abstract
Background The cumulative body of research on suicidality in later life describes its unique and complex features in older people when compared with that in other population groups. Yet significant gaps exist in how research informs the further development of suitable interventions. The perspectives of older people are also limited in research findings. Aims Therefore, this exploratory study aimed to (1) identify potential barriers and enablers in discussing suicidal thoughts and their expression in later life from the perspectives of lay older people and (2) explore where opportunities might occur in approach, place, relationships, and language with older people to discuss suicidal thoughts and their expression. Method We conducted in-depth qualitative individual interviews with 15 people aged 70-89 years. This method helped explore older peoples' own lay perspectives on suicidal thoughts in later life and how these are expressed, and their understanding of where and how people might seek support. Results A total of three themes were generated from the dataset: (1) intergenerational and socio-cultural differences in suicide expression, (2) the normalization of suicidal thoughts in later life, and (3) the importance and difficulties of everyday discussion and opportunities to express suicidal thoughts. Conclusion Suicidal thoughts and their expression appear commonly and are normalized in later life yet remain taboo and hidden. The participants revealed how such thoughts and behaviors are typically expressed through colloquial or "off-hand" remarks and comments and the importance of authentic listening. The findings highlight the importance of more informal discussions around these topics and how care professionals, practitioners, and providers might frame opportunities for dialogue with people who may want to access support. Further engagement with community-informed participatory research methods in which older people provide their own perspectives and experiences is important in addressing these gaps. There is a need for co-designing in developing screening, assessment, and signposting outside of clinical settings that can be used in everyday caring relationships with people in later life.
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Affiliation(s)
- Trish Hafford-Letchfield
- School of Social Work and Social Policy, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Jeffrey R. Hanna
- School of Social Work and Social Policy, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Toby J. Ellmers
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Susan Rasmussen
- School of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Nicola Cogan
- School of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Helen Gleeson
- School of Mental Health and Social Work, School of Education, Middlesex University, London, United Kingdom
| | | | - Sophie Martin
- School of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Patrick Walker
- School of Social Work and Social Policy, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Matthew Quaife
- School of Mental Health and Social Work, School of Education, Middlesex University, London, United Kingdom
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17
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Hu F, Zhao D, Fu X, Zhang W, Tang W, Hu S, Shen W, Chen H. Gender differences in suicidal ideation, suicide attempts, and suicide death among people living with
HIV
: A systematic review and meta‐analysis. HIV Med 2022; 24:521-532. [PMID: 36347514 DOI: 10.1111/hiv.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although excess mortality, especially suicide, is a critical trait in people living with HIV, consensus about gender differences in these areas is lacking. We conducted meta-analyses to examine gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV. METHODS We systematically searched PubMed and Web of Science for studies written in English. In this review, suicide among people living with HIV includes suicide death, suicidal ideation, and suicide attempts. Studies reporting the suicide prevalence among males and females living with HIV were eligible for inclusion in our review. Odds ratios (ORs) and 95% confidence intervals (CIs) served as the effect size index. Fixed-effects or random-effects meta-analyses were chosen based on the size of the heterogeneity. RESULTS A total of 27 studies comprising 801 017 participants from 11 countries were included in the meta-analysis. The overall prevalence of suicidal ideation was 18.0% (95% CI 13.3%-22.8%) in males and 20.8% (95% CI 16.4%-25.1%) in females, and there was a statistically significant higher risk of suicidal ideation in females living with HIV (OR 1.30; 95% CI 1.09-1.56; p < 0.05). The overall prevalence of suicide attempts was 16.8% (95% CI 9.0%-24.5%) in males and 24.7% (95% CI 12.4%-37.1%) in females, and there was a statistically significant higher risk of suicide attempts in females living with HIV (OR 1.34; 95% CI 1.02-1.75; p < 0.05). The pooled prevalence of suicide death was 1.2% (95% CI 0.5%-1.9%) among males and 0.2% (95% CI 0.1%-0.3%) among females, and the risk of suicide death between genders was not statistically significant (OR 0.78; 95% CI 0.50-1.24; p = 0.298). CONCLUSIONS There were gender differences in suicidal ideation and suicide attempts among people living with HIV. Females living with HIV were more likely to experience suicidal ideation and make suicide attempts, but there were no statistically significant gender differences in suicide death. Appropriate initiatives to optimize the recognition, treatment, and management suicide behaviours of males and females living with HIV may narrow this gender gap.
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Affiliation(s)
- Fei‐Hong Hu
- School of Medicine Nantong University Nantong China
| | - Dan‐Yan Zhao
- School of Medicine Nantong University Nantong China
| | - Xue‐Lei Fu
- School of Medicine Nantong University Nantong China
| | | | - Wen Tang
- School of Medicine Nantong University Nantong China
| | - Shi‐Qi Hu
- School of Medicine Nantong University Nantong China
| | | | - Hong‐Lin Chen
- School of Public Health Nantong University Nantong China
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18
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Lett E, Abrams MP, Moberg E, Benson GP, Perlson JE. Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2293-2304. [PMID: 35962805 DOI: 10.1007/s00127-022-02348-1] [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: 02/18/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination. METHODS We used data on substance use, depressive symptoms, suicidality, and social-structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social-structural factors, and suicidality. RESULTS A three-class LCA solution identified a subset of student respondents in a "high use" latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR: 1.58; 95% CI: 1.28-1.95) and housing insecurity (aOR: 8.78; 95% CI: 4.35-17.71) were associated with increased odds of "high use" class membership relative to the "no use" class membership. "High use" class membership was associated with increased odds of suicidal ideation (aOR: 2.26; 95% CI: 1.75-2.94), plans (aOR: 2.59; 95% CI: 2.01-3.36), and attempts (aOR: 6.85; 95% CI: 3.17-15.68). CONCLUSION The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.
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Affiliation(s)
- Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA, 19146, USA. .,Center for Applied Transgender Studies, Chicago, IL, USA.
| | - Matthew P Abrams
- Center for Emergency Care Policy and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Medicine Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emery Moberg
- Unaffiliated Recent College Graduate, Los Angeles, CA, USA
| | - G Perusi Benson
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - Jacob E Perlson
- Department of Psychiatry, Columbia University, New York, NY, USA
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19
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Sullins DP. Sexual Orientation Change Efforts Do Not Increase Suicide: Correcting a False Research Narrative. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3377-3393. [PMID: 36066677 DOI: 10.1007/s10508-022-02408-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 05/25/2023]
Abstract
Sexual orientation change efforts (SOCEs) signify activities designed to change or reduce homosexual orientation. Recent studies have claimed that such therapies increase suicide risk by showing positive associations between SOCE and lifetime suicidality, without excluding behavior that pre-dated SOCE. In this way, Blosnich et al.'s (2020) recent analysis of a national probability sample of 1518 sexual minority persons concluded that SOCE "may compound or create…suicidal ideation and suicide attempts" but after correcting for pre-existing suicidality, SOCE was not positively associated with any form of suicidality. For suicidal ideation, Blosnich et al. reported an adjusted odds ratio (AOR) of 1.92 (95% CI 1.01-3.64); the corrected AOR was .44 (.20-.94). For suicide planning, Blosnich et al.'s AOR was 1.75 (1.01-3.06); corrected was .60 (.32-1.14). For suicide attempts, Blosnich et al.'s AOR was 1.75 (.99-3.08); corrected was .74 (.36-1.43). Undergoing SOCE after expressing suicidal behavior reduced subsequent suicide attempts from 72 to 80%, compared to those not undergoing SOCE, when SOCE followed a prior expression of suicidal ideation (AOR .17, .05-.55), planning (AOR .13, .04-.45) or intention (AOR .10, .03-.30); however, SOCE following an initial suicide attempt did not significantly reduce further attempts. By violating the principle that a cause cannot occur after an effect, Blosnich et al. misstated the correct conclusion. Experiencing SOCE does not result in higher suicidality, as they claim, and may sharply reduce subsequent suicide attempts. Restrictions on SOCE will not reduce suicidal risk among sexual minorities and may deprive them of an important resource for reducing suicide attempts.
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Affiliation(s)
- D Paul Sullins
- Department of Sociology, The Catholic University of America, Washington, DC, 20064, USA.
- Ruth Institute, Lake Charles, LA, USA.
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20
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Bornheimer LA, Czyz E, Koo HJ, Li Verdugo J, Eisenberg D, Zheng K, Pistorello J, Albucher RC, Coryell W, Favorite T, King CA. Suicide risk profiles and barriers to professional help-seeking among college students with elevated risk for suicide. J Psychiatr Res 2022; 152:305-312. [PMID: 35772258 PMCID: PMC10653046 DOI: 10.1016/j.jpsychires.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/20/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022]
Abstract
Suicide is the second leading cause of death among college students, yet many students with elevated suicide risk do not seek professional help. This study identified suicide risk profiles among college students and examined these in relation to students' perceived barriers to professional help-seeking. Data were obtained from college students (n = 1689) identified to be at elevated risk for suicide based at four US universities. Latent class analysis was performed to determine risk profiles, followed by examinations of differences in help-seeking barriers by profile groupings. Results revealed three student groupings: (1) moderate internalizing and externalizing symptoms (with low alcohol misuse), (2) highest internalizing and externalizing symptoms (with highest social disconnection), and (3) lowest internalizing symptoms and low externalizing (with highest social connection and alcohol misuse). Group 1 included the youngest and most racially and sexually diverse students, Group 2 endorsed the most help-seeking barriers, and Group 3 endorsed the fewest barriers. Group 2 is especially concerning, considering the severe clinical characteristics, high number of barriers, and low connectedness to others for potential support. Understanding these differences across risk and barrier profiles is an important step towards developing tailored approaches to increase mental health care in college populations.
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Affiliation(s)
- Lindsay A Bornheimer
- University of Michigan, School of Social Work, USA; University of Michigan, Department of Psychiatry, USA; University of Michigan Depression Center, USA; University of Michigan, Injury Prevention Center, USA.
| | - Ewa Czyz
- University of Michigan, Department of Psychiatry, USA
| | - Hyun Jung Koo
- University of Michigan, Department of Psychiatry, USA
| | | | - Daniel Eisenberg
- University of California, Los Angeles, Fielding School of Public Health, USA
| | - Kai Zheng
- University of California, Irvine, Donald Bren School of Information and Computer Sciences, USA
| | | | - Ronald C Albucher
- Stanford University, Department of Psychiatry, Counseling and Psychological Services, USA
| | | | - Todd Favorite
- University of Michigan, Mary A. Rackham Institute, USA
| | - Cheryl A King
- University of Michigan, Department of Psychiatry, USA; University of Michigan Depression Center, USA; University of Michigan, Injury Prevention Center, USA; University of Michigan, Department of Psychology, USA
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21
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Cecchin HFG, Murta SG, de Macedo EOS, Moore RA. Scoping review of 30 years of suicide prevention in university students around the world: efficacy, effectiveness, and cost-effectiveness. PSICOLOGIA, REFLEXAO E CRITICA : REVISTA SEMESTRAL DO DEPARTAMENTO DE PSICOLOGIA DA UFRGS 2022; 35:22. [PMID: 35856124 PMCID: PMC9294115 DOI: 10.1186/s41155-022-00227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022]
Abstract
A scoping review of systematic reviews was carried out to identify evidence of efficacy, effectiveness, and cost-effectiveness of universal and selective suicide prevention programs among university students worldwide. Five databases were reviewed using terms in English, Spanish, and Portuguese. The following were the inclusion criteria: systematic review or meta-analysis or meta-synthesis, suicide prevention in college students, evaluation of the efficacy, effectiveness and/or cost-effectiveness of interventions, and peer-reviewed studies. The quality of reviews was assessed. The field of study features three decades of publication in high-income countries. The strategy used, the components of the program, and the target audience to which they are delivered interfere with efficacy. In the psychoeducation strategy, the experiential and didactic components are more efficacious in the knowledge about suicide. And the motivational enhancement component promotes greater self-efficacy in suicide prevention. Programs that take a multimodal approach are effective in increasing short-term attitudes related to suicide and reducing rates of completed suicide. The gatekeeper strategy delivered to peer counselors is the most effective one in the outcomes, including short-term and long-term knowledge about suicide and its prevention and self-efficacy in suicide prevention. A greater number of evaluated studies of gatekeeper interventions were identified, indicating a trend in this research field. No review addressed the effects on subgroups that were classified based on sex, racial or sexual minorities, and special (indigenous) populations. Only one study addressed cost-effectiveness, pointing out that the psychoeducation and gatekeeper strategies have relevant net benefit rates, but the gatekeeper strategy has a higher cost–benefit ratio compared to the psychoeducation strategy. The findings indicate that psychoeducation and gatekeeper interventions tend to be more efficacious when they combine education and skills training to intervene in suicidal behavior. The components of the intervention and the target audience to which it is delivered influence efficacy. Multimodal interventions evaluate completed suicide outcomes, but require greater implementation efforts, in terms of human and financial resources and more time for the evaluation.
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Affiliation(s)
- Hareli Fernanda Garcia Cecchin
- Universidade Federal do Tocantins, Pró-reitoria de Assuntos Estudantis - PROEST, Quadra 109 Norte, Avenida NS-15, Prédio da Reitoria, Plano Diretor Norte, 77001-090, Palmas, Tocantins, Brazil.
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22
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What Are Complex Interventions in Suicide Research? Definitions, Challenges, Opportunities, and the Way Forward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148591. [PMID: 35886443 PMCID: PMC9315522 DOI: 10.3390/ijerph19148591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/10/2022]
Abstract
It has been argued that effective action towards addressing a complex concern such as suicide requires a combination of evidence-based strategies. While these complex public health approaches have recently gained importance, little is known about their characteristics and what contributes to their complexity. The use of interchangeable terms such as multilevel, multicomponent, community based, and inconsistent definitions of these approaches creates confusion around what it is and what it is not. In practice, this disorder is reflected in a substantial variation in the design, implementation, and evaluation of complex approaches in suicide research. While it is impossible to resolve all existing inconsistencies in terminology, this review explores a range of terms and definitions to connote complex interventions. It aims to unpack multiple meanings of these terms and their diverse usage in suicide literature. The potential implications of this fluidity and plausible pathways to make sense of this complexity for suicide research are also discussed. With a shared understanding of what constitutes a complex intervention, we can expect to see an improved representation of the real-world complexities in our efforts to address suicide. This common language can also contribute toward quality implementation and dissemination and thereby advance our understanding of complex interventions.
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Fortune S, Hetrick S, Sharma V, McDonald G, Scott KM, Mulder RT, Hobbs L. Multisite sentinel surveillance of self-harm in New Zealand: protocol for an observational study. BMJ Open 2022; 12:e054604. [PMID: 35613789 PMCID: PMC9134176 DOI: 10.1136/bmjopen-2021-054604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION New Zealand (NZ) has a persistently high rate of suicide, particularly among young people. Hospital presentation for self-harm (SH) is one of the strongest predictors of death by suicide. Improving the monitoring of SH and suicide is a key recommendation for suicide prevention by WHO. This study will establish the first ever sentinel surveillance for SH at several large hospitals and a monthly survey of all practicing paediatricians in NZ. The study will provide robust information about the epidemiology of SH, factors associated with SH and the types of interventions required for those presenting to hospital with SH. METHOD AND ANALYSIS This observational study will establish SH surveillance in the emergency departments of three public hospitals for the first time in NZ, where study population will include individuals of all ages who present with SH or suicidal ideation. The study methodology is in line with the WHO Best Practice guidelines and international collaborators in Australia and Europe. Electronic triage records will be reviewed manually by the research team to identify potential cases that meet inclusion criteria. For all eligible cases, variables of interest will be extracted from routine clinical records by the research team and recorded on a secure web-based survey application. Additionally, SH surveillance data for the national paediatric population (<15 years) will be obtained via the New Zealand Paediatric Surveillance Unit (NZPSU); paediatricians will report on included cases using the same variables using a secure survey application. A deidentified dataset will be produced for aggregated statistical analysis. ETHICS AND DISSEMINATION The University of Otago Health Ethics Committee granted ethical approval for this study in addition to local ethics approval at participating hospital sites. The study findings will be disseminated to relevant stakeholders in NZ, in addition to international audiences through publications in peer-reviewed scientific journals and conference presentations.
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Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- The Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Hetrick
- Department of Psychological Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Vartika Sharma
- Department of Psychological Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Gabrielle McDonald
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Kate M Scott
- The Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Linda Hobbs
- The Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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24
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Ingram J, Lyford B, McAtamney A, Fitzpatrick S. Preventing suicide in refugees and asylum seekers: a rapid literature review examining the role of suicide prevention training for health and support staff. Int J Ment Health Syst 2022; 16:24. [PMID: 35562790 PMCID: PMC9107234 DOI: 10.1186/s13033-022-00534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Refugees and asylum seekers are exposed to a unique set of circumstances and experiences that are associated with an increased suicide risk. Suicide prevention training has been recognised as a central component supporting a comprehensive approach to suicide prevention. Limited literature exists exploring the role of suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Methods To determine the impact suicide prevention training for health staff may have in supporting refugee and asylum seeker suicide prevention, researchers undertook a rapid literature review exploring what elements should be considered when developing suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Results Results of academic and grey literature screening identified 14 studies exploring suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Findings of the literature review suggest suicide prevention training for health and support staff working with refugee and asylum seekers should consider the inclusion of content which increases participant competence and confidence to identify and respond to suicide risk; provide staff with an understanding of cultural differences and its impact on refugees and asylum seekers recognition of mental health and suicide as a health matter; highlight the importance trauma informed practices in care and consider the lived experience of refugees and asylum seekers. Conclusions Inclusion of specific content in refugee and asylum seeker suicide prevention training may provide health and support staff increased competence and confidence to identify and respond to suicide risk in refugees and asylum seekers.
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Affiliation(s)
| | - Bronte Lyford
- Everymind, 72 Watt St, Newcastle, NSW, 2300, Australia.,School of Medicine and Public Health, University of Newcastle, College of Health, Medicine and Wellbeing, NSW, 2308, Callaghan, Australia
| | | | - Sally Fitzpatrick
- Everymind, 72 Watt St, Newcastle, NSW, 2300, Australia.,School of Medicine and Public Health, University of Newcastle, College of Health, Medicine and Wellbeing, NSW, 2308, Callaghan, Australia
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25
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Farahbakhsh M, Azizi H, Fakhari A, Esmaeili ED, Barzegar H, Sarbazi E. Developing a Community-based Suicide Prevention Program in Primary Health Care. Community Ment Health J 2022; 58:713-719. [PMID: 34259967 DOI: 10.1007/s10597-021-00875-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022]
Abstract
Currently, suicide has become one of the most critical public health challenges in low-and middle-income countries facing community mental health more broadly. However, most healthcare systems haven't efficient Suicide Prevention Programs (SPP), and only 18% of countries have a suicide registry system. In Malekan County of Iran, suicidal behaviors were recognized as a serious public health issue via a health community assessment. This study was aimed to describe the developing steps of a community-based SPP in Malekan County including review of systematic reviews, expert testimony, report to the health system, improving suicide registry coverage, conducting research, follow upping of suicide attempters, training gatekeepers, and public education campaign in the hot spots. These suggested the need to reinforce evaluate the effectiveness of the national health perspective in addressing the issues of suicide and suicidal behavior.
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Affiliation(s)
- Mostafa Farahbakhsh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hosein Azizi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Fakhari
- Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Sciences, Tabriz, Iran.,Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Habibeh Barzegar
- Research Center of Psychiatry and Behavioral Science, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Sarbazi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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26
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King K, Hall T, Oostermeijer S, Currier D. Community participation in Australia's National Suicide Prevention Trial. Aust J Prim Health 2022; 28:255-263. [PMID: 35473643 DOI: 10.1071/py21083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND National systems-based suicide prevention approaches are increasingly being implemented. Community participation is fundamental to the successful implementation of these approaches, but can be challenging to undertake. We present findings from the evaluation of Australia's National Suicide Prevention Trial (the Trial). METHODS We completed consultations with 127 community members and 46 Primary Health Network (PHN) staff. Thematic analysis was undertaken to understand the process of community participation in the planning and implementation of the Trial. RESULTS Themes were identified regarding: a collaborative PHN; an engaged and passionate community; maintaining engagement; getting the right people involved; and getting stakeholders to work together. Continuous negotiation about Trial ownership, acceptability of the Trial model, and choice of activities was required. Community participation was somewhat challenging for PHNs, taking much longer than anticipated for a range of reasons. CONCLUSIONS Future system-based approaches could benefit from the provision of community participation skills training and support to enable a more coordinated, and perhaps more easily achieved, approach to the involvement of community. Despite a long process of relationship building between stakeholders, this led to improved community cohesion and integration in local suicide prevention, ready for future collaborative work.
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Affiliation(s)
- Kylie King
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Vic. 3168, Australia
| | - Teresa Hall
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Sanne Oostermeijer
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Dianne Currier
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia
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27
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Turmaine K, Dumas A, Chevreul K. Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis. J Med Internet Res 2022; 24:e30218. [PMID: 35451977 PMCID: PMC9077507 DOI: 10.2196/30218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/23/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. Objective To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. Methods The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. Results Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. Conclusions These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-04464-2
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Affiliation(s)
| | - Agnès Dumas
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France
| | - Karine Chevreul
- Université Paris Cité, ECEVE, UMR 1123, Inserm, Paris, France.,Assistance Publique-Hôpitaux de Paris, URC Eco Ile-de-France, Paris, France, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'épidémiologie clinique, Paris, France
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- See Authors' Contributions,
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28
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Laflamme L, Vaez M, Lundin K, Sengoelge M. Prevention of suicidal behavior in older people: A systematic review of reviews. PLoS One 2022; 17:e0262889. [PMID: 35077476 PMCID: PMC8789110 DOI: 10.1371/journal.pone.0262889] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/09/2022] [Indexed: 01/08/2023] Open
Abstract
Older people have the highest rates of suicide, yet the evidence base on effective suicide preventions in late-life is limited. This systematic review of reviews aims to synthesize data from existing reviews on the prevention and/or reduction of suicide behavior in late-life and evidence for effectiveness of interventions. A systematic database search was conducted in eight electronic databases from inception to 4/2020 for reviews targeting interventions among adults ≥ 60 to prevent and/or reduce suicide, suicide attempt, self-harm and suicidal ideation. Four high quality reviews were included and interventions categorized as pharmacological (antidepressant use: 239 RCTs, seven observational studies) and behavioral (physical activity: three observational studies, and multifaceted primary-care-based collaborative care for depression screening and management: four RCTs). The 2009 antidepressant use review found significant risk reduction for suicide attempt/self-harm (OR = 0.06, 95% CI 0.01-0.58) and suicide ideation (OR = 0.39, 95% CI 0.18-0.78) versus placebo. The 2015 review found an increased risk of attempts with antidepressants versus no treatment (RR = 1.18, 95% CI 1.10-1.27) and no statistically significant change in suicides versus no treatment (RR = 1.06, 95% CI 0.68-1.66) or ideation versus placebo (OR = 0.52, 95% CI 0.14-1.94). Protective effects were found for physical activity on ideation in 2 out of 3 studies when comparing active versus inactive older people. Collaborative care demonstrated significantly less attempts/ideation (OR = 0.80, 95% CI 0.68-0.94) in intervention group versus usual care. The results of this review of reviews find the evidence inconclusive towards use of antidepressants for the prevention of suicidal behavior in older people, thus monitoring is required prior to start, dosage change or cessation of antidepressants. Evidence to date supports physical activity and collaborative management for reduction of suicide ideation, but additional trials are required for a meta-analysis. To build on these findings, continued high-quality research is warranted to evaluate the effectiveness of interventions in late life.
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Affiliation(s)
- Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Insurance Medicine, Stockholm, Sweden
| | - Karima Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mathilde Sengoelge
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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29
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Revisiting evidence of primary prevention of suicide among adult populations: A systematic overview. J Affect Disord 2022; 297:641-656. [PMID: 34728288 DOI: 10.1016/j.jad.2021.10.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUNDS Primary prevention of suicidal behaviors in the general population is required to interrupt the trend of self-inflicted deaths worldwide. We reviewed the evidence of the efficacy of primary prevention of suicide among the adult population. METHODS This is an overview of systematic reviews. We searched PubMed, EMBASE, Scopus, PsycINFO, and Cochrane databases to identify articles on suicide prevention strategies in non-clinical populations. For the purpose of overview, only systematic reviews were eligible. Primary outcomes: The outcomes of the present study were changes in the number of suicide death or suicide behaviors. Two reviewers assessed the methodological quality and the risk of bias of included studies. RESULTS From the initial 2,315 records, 32 articles met inclusion criteria. Evidence of reduction of suicide-related outcomes was detected, but of small magnitude. Most multicomponent prevention programs were delivered to specific populations, comprising strategies such as restriction to lethal means, educational programs, and gatekeeper training. Means restriction was the single intervention that showed some evidence of individual efficacy in reducing suicide. There is evidence that poor quality of media reporting is related with increasing suicide and better-quality reports could help suicide prevention. Most of the included SRs were of critically-low methodological quality. LIMITATIONS Publication bias, reporting bias, study designs, outcome definition and article overlap across studies are the main concerns. CONCLUSIONS Multicomponent programs and means restriction have indicated a reduction of suicide rates, mainly in specific populations. There is insufficient evidence to recommend a widespread implementation of suicide primary prevention in the general population.
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30
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Reifels L, Krishnamoorthy S, Kõlves K, Francis J. Implementation Science in Suicide Prevention. CRISIS 2022; 43:1-7. [PMID: 35016534 DOI: 10.1027/0227-5910/a000846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Sadhvi Krishnamoorthy
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, QLD, Australia.,WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Jillian Francis
- School of Health Sciences, The University of Melbourne, VIC, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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31
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Zbukvic I, Rheinberger D, Rosebrock H, Lim J, McGillivray L, Mok K, Stamate E, McGill K, Shand F, Moullin JC. Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895211065786. [PMID: 37091106 PMCID: PMC9924249 DOI: 10.1177/26334895211065786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.
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Affiliation(s)
- Isabel Zbukvic
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Demee Rheinberger
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Hannah Rosebrock
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jaclyn Lim
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren McGillivray
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Katherine Mok
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Eve Stamate
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
| | - Katie McGill
- MH-READ, Hunter New England Mental Health Services, Newcastle, New South Wales, Australia
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Fiona Shand
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Joanna C Moullin
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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32
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Boggs JM, Quintana LM, Powers JD, Hochberg S, Beck A. Frequency of Clinicians' Assessments for Access to Lethal Means in Persons at Risk for Suicide. Arch Suicide Res 2022; 26:127-136. [PMID: 32379012 DOI: 10.1080/13811118.2020.1761917] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We measured the frequency of clinicians' assessments for access to lethal means, including firearms and medications in patients at risk of suicide from electronic medical and mental health records in outpatient and emergency settings. METHODS We included adult patients who reported suicide ideation on the PHQ-9 depression screener in behavioral health and primary care outpatient settings of a large integrated health system in the U.S. and those with suicidal behavior treated in the emergency department. Two separate natural language processing queries were developed on medical record text documentation: (1) assessment for access to firearms (8,994 patients), (2) assessment for access to medications (4,939 patients). RESULTS Only 35% of patients had documentation of firearm or medication assessment in the month following treatment for suicidal behavior in the emergency setting. Among those reporting suicidal ideation in outpatient setting, 31% had documentation of firearm assessment and 23% for medication assessment. The accuracy of the estimates was very good for firearm assessment (F1 = 89%) and medication assessment in the outpatient setting (F1 = 91%) and fair for medication assessment in the emergency setting (F1 = 70%) due to more varied documentation styles. CONCLUSIONS Lethal means assessment following report of suicidal ideation or behavior is low in a nonacademic health care setting. Until health systems implement more structured documentation to measure lethal means assessment, such as discrete data field, NLP methods may be used to conduct research and surveillance of this important prevention practice in real-world settings.
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33
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Maghsoodi S, Vafadoost Z. The Relationship between Health-promoting Lifestyle and Suicidal Ideation in Addicted Women. ADDICTION & HEALTH 2022; 14:44-51. [PMID: 35573765 PMCID: PMC9057641 DOI: 10.22122/ahj.v14i1.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/24/2021] [Indexed: 11/13/2022]
Abstract
Background Addiction is one of the most important problems of the present century that can be the basis of many social and family problems. Addiction severely affects the physical and mental health and lifestyle of addicted people and sometimes leads to suicide. The aim of this study was to investigate the relationship between health-promoting lifestyle and suicidal ideation in addicted women. Methods In this descriptive-correlational study, the statistical population included all addicted women who referred to psychiatric hospitals in Kerman, Iran, in 2020, among whom 118 people were selected using convenience sampling method. Data were collected using Beck Depression Inventory (BDI) (1974) and were analyzed using Spearman's correlation coefficient test. Findings 44.9% of women had no suicidal ideation, 23.7% were ready to commit suicide, and 30.5% attempted suicide. There was a significant inverse relationship between health-promoting lifestyle and its components (nutrition, physical activity, health responsibility, stress management, interpersonal relationships, and spiritual growth) with suicidal ideation. Conclusion The results of this study can have important applications in the care and rehabilitation of addicted people and reduce suicidal ideation among them. In the rehabilitation of addicted people, one of the important goals should be improving the quality of life (QOL) and lifestyle of these people.
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Affiliation(s)
- Soodeh Maghsoodi
- Department of Social Sciences, School of Literature and Humanities, Shahid Bahonar University of Kerman, Kerman, Iran,Correspondence to: Soodeh Maghsoodi; Department of Social Sciences, School of Literature and Humanities, Shahid Bahonar
University of Kerman, Kerman, Iran;
| | - Zahra Vafadoost
- Department of Social Sciences, School of Literature and Humanities, Shahid Bahonar University of Kerman, Kerman, Iran
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34
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Bellairs-Walsh I, Byrne SJ, Bendall S, Perry Y, Krysinska K, Lin A, Michail M, Lamblin M, Li TY, Hetrick S, Robinson J. Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12926. [PMID: 34948536 PMCID: PMC8701929 DOI: 10.3390/ijerph182412926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Sadhbh J. Byrne
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Global Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Sarah Bendall
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Yael Perry
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK;
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Tina Yutong Li
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Townsville University Hospital, Douglas, QLD 4814, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
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Braun M, Till B, Pirkis J, Niederkrotenthaler T. Effects of suicide prevention videos developed by and targeting adolescents: a randomized controlled trial. Eur Child Adolesc Psychiatry 2021; 32:847-857. [PMID: 34817663 PMCID: PMC8611173 DOI: 10.1007/s00787-021-01911-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
Suicide prevention videos featuring young people's personal narratives of hope and recovery are increasingly used in suicide prevention, but research on their effects is scarce. A double-blind randomized controlled trial was conducted to test the effects of a suicide prevention video featuring an adolescent mastering his suicidal ideation by getting help on 14 to 19-year-olds. N = 299 adolescents were randomly allocated to watch the intervention video (n = 148) or a control video unrelated to mental health (n = 151). Questionnaire data were collected before (T1) and immediately after exposure (T2), and 4 weeks later (T3). Data were analyzed with a repeated-measures ANCOVA. The primary outcome was suicidal ideation, assessed with the Reasons for Living Inventory for Adolescents. Secondary outcomes were help-seeking intentions, attitudes towards suicide, stigmatization of suicidality, and mood. There was an immediate beneficial effect of the intervention on suicidal ideation (T2 mean change from baseline within intervention group MChange = - 0.16 [95% CI - 0.20 to - 0.12], mean difference compared to control group MDiff = - 0.09 [95% CI - 0.15 to - 0.03], ηp2 = 0.03), which was not maintained at T3. Participants reported significantly higher help-seeking intentions, which was maintained at 4-week follow-up. They also reported a sustained reduction of favorable attitudes to suicide. Effects on suicidal ideation were mediated by identification with the featured protagonist. Adolescents appear to benefit from suicide prevention narratives featuring personal stories from peers on coping with suicidal ideation and help-seeking.Trial registration DRKS00017405; 24/09/19; retrospectively registered.
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Affiliation(s)
- Marlies Braun
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Benedikt Till
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Thomas Niederkrotenthaler
- Unit Suicide Research & Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
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Stapelberg NJC, Bowman C, Woerwag-Mehta S, Walker S, Davies A, Hughes I, Michel K, Pisani AR, Van Engelen H, Delos M, Hageman T, Fullerton-Smith K, Krishnaiah R, McDowell S, Cameron A, Scales TL, Dillon C, Gigante T, Heddle C, Mudge N, Zappa A, Edwards M, Gutjahr S, Joshi H, Turner K. A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP). Trials 2021; 22:723. [PMID: 34674732 PMCID: PMC8529364 DOI: 10.1186/s13063-021-05658-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. Methods This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. Discussion This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. Trials registration ClinicalTrials.govNCT04072666. Registered on 28 August 2019
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Affiliation(s)
- Nicolas J C Stapelberg
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.,Faculty Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Queensland, 4226, Australia
| | - Candice Bowman
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.
| | - Sabine Woerwag-Mehta
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.,Faculty Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Queensland, 4226, Australia
| | - Sarah Walker
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Angela Davies
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.,Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast Health, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Konrad Michel
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anthony R Pisani
- Departments of Psychiatry and Pediatrics, University of Rochester, 300 Crittenden Blvd., BOX PSYCH, Rochester, NY, 14642, USA
| | - Heidy Van Engelen
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Mia Delos
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Tamara Hageman
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Kim Fullerton-Smith
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Ravikumar Krishnaiah
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Sarah McDowell
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Alison Cameron
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Trudy-Lee Scales
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Cherie Dillon
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Titta Gigante
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.,Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Cindy Heddle
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Natalie Mudge
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Anne Zappa
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Michelle Edwards
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.,Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Sigi Gutjahr
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Hitesh Joshi
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Kathryn Turner
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
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Trachik B, Moscardini EH, Ganulin ML, McDonald JL, McKeon AB, Dretsch MN, Tucker RP, Sowden WJ. Perceptions of purpose, cohesion, and military leadership: A path analysis of potential primary prevention targets to mitigate suicidal ideation. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1962184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Emma H. Moscardini
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | | | - Ashlee B. McKeon
- The Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | | | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Walter J. Sowden
- The Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Department of Behavioral Health, Tripler Army Medical Center (Tripler AMC), Honolulu, Hawaii, USA
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Lawrence KC. Structural equation modelling of risk indicators for suicidal thoughts and behaviours among Nigerian Yorùbá youth. JOURNAL OF PSYCHOLOGY IN AFRICA 2021. [DOI: 10.1080/14330237.2021.1952623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kehinde Clement Lawrence
- Department of Educational Psychology and Special Education, University of Zululand, KwaDlangezwa, South Africa
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Outcomes of community-based suicide prevention program in primary health care of Iran. Int J Ment Health Syst 2021; 15:67. [PMID: 34348779 PMCID: PMC8336287 DOI: 10.1186/s13033-021-00492-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/27/2021] [Indexed: 01/20/2023] Open
Abstract
Background Suicidal management and prevention in communities, especially in its first stages, is an effective intervention for the health systems. However, in numerous societies most cases go undetected. Primary Health Care (PHC) is an effective place for the management of Suicide Prevention Programs (SPP). In Malekan County, a health community assessment found suicide as the most important health problem. A regional SPP was performed for suicide prevention during 2014–2017. Methods This study was carried out in six steps: (1) Establishing a research team, (2) Improving a registry for suicidal behaviors (SBs), (3) Identifying local determinants of SBs, (4) Training healthcare providers, (5) Follow-up and monitoring of SBs, and (6) Public awareness campaigns. Our ultimate goal was to lower the rates of suicide, and suicide attempt (SA) by 15 and 20 %, respectively. Multiple logistic regression was used to estimate the adjusted odds ratios and the 95% confidence intervals. Results A total of 821 SAs and 32 suicides were identified. The gender distribution for suicides was 70% males whereas SAs were 64% among females. The majority of suicides occurred in spring 18 (56.25%) while summer was the most common season among SAs 288 (35.8%). Almost 62 and 75% of suicides and SAs have used hanging and poisoning methods, respectively. Hanging increased suicide risk significantly (OR: 8.5, 95% CI 2.9–76.99). During the study, 93 life-skill and parenting education sessions were held. The incidence rates of suicide and SA decreased from 11.22, and 203 per 100,000 in 2013 to 2.63, and 157 in 2017, respectively. Similarly, the re-attempt to SAs ratio decreased from 12% to 2013 to 6.7% in 2017. Moreover, more than 8% of SBs were collected from adjacent Counties. Conclusions At the study end, suicide, SA, and re-attempt were lowered by 75%, 22%, and 42%, respectively. The practical framework that achieved in this study could be used as a basis for developing future SPPs and suicide researches in the Iranian context. Furthermore, the various socio-economic and socio-cultural challenges highlight the need to consider a wide range of contextual factors when developing an SPP.
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40
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Wilks CR, Chu C, Sim D, Lovell J, Gutierrez P, Joiner T, Kessler RC, Nock MK. User Engagement and Usability of Suicide Prevention Apps: Systematic Search in App Stores and Content Analysis. JMIR Form Res 2021; 5:e27018. [PMID: 34259163 PMCID: PMC8319780 DOI: 10.2196/27018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 01/27/2023] Open
Abstract
Background People with suicidal thoughts are more inclined to seek technology-delivered interventions than in-person forms of treatment, making mobile apps for suicide prevention an ideal platform for treatment delivery. This review examines apps designed for suicide prevention, with a specific focus on user engagement. Objective This study aims to update the literature and broadly evaluate the landscape of mobile health apps for suicide prevention; examine apps with key features and primary approaches to suicide prevention; and systematically evaluate the engagement, functionality, aesthetics, and information of the apps. Methods All apps related to suicidal thoughts and behaviors were identified in the Google Play and iOS app stores and were systematically reviewed for their content and quality. The mobile app rating scale (MARS) was used to evaluate app usability and engagement. Results Of the 66 apps identified, 42 (64%) were specifically designed for people with suicidal ideation, and 59 (89%) had at least one best practice feature for suicide risk reduction. The mean overall MARS score of all apps was 3.5 (range 2.1-4.5), with 83% (55/66) of apps having a minimum acceptability score of 3. The total MARS score was not associated with the user app rating (r=−0.001; P=.99) or the number of features (r=0.24; P=.09). Conclusions This study identified many usable and engaging apps in app stores designed for suicide prevention. However, there are only limited apps for clinicians. Thus, mobile apps for suicide prevention should be carefully developed and clinically evaluated.
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Affiliation(s)
- Chelsey R Wilks
- Department of Psychological Sciences, University of Missouri-St. Louis, St Louis, MO, United States
| | - Carol Chu
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - DongGun Sim
- School of Theology, Boston University, Boston, MA, United States
| | - Josh Lovell
- Department of Psychology, Hofstra University, Hempstead, NY, United States
| | - Peter Gutierrez
- Rocky Mountain Regional VA Medical Center, Denver, CO, United States.,University of Colorado Anschutz Medical Campus, Denver, CO, United States
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
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Mason K, Geist M, Kuo R, Marshall D, Wines JD. Clergy as Suicide Prevention Gatekeepers. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2021; 75:84-91. [PMID: 34137332 DOI: 10.1177/1542305020974997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
801 U.S. Catholic, Jewish and Protestant clergy reported on their suicide gatekeeping activities. Using vignettes, they identified suicide risk and selected interventions for three risk levels. Two-thirds of the sample who provide counseling reported at least one contact from a suicidal person per year. Clergy were significantly more concurrent with experts in identifying risk and selecting interventions with high risk but deviated more from the experts with low and medium risk. Most reported needing more training.
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Affiliation(s)
- Karen Mason
- Counseling Department, Gordon-Conwell Theological Seminary, USA
| | - Monica Geist
- Mathematics Department, Front Range Community College, USA
| | - Richard Kuo
- Counseling Department, Gordon-Conwell Theological Seminary, USA
| | - Day Marshall
- Counseling Department, Gordon-Conwell Theological Seminary, USA
| | - James D Wines
- Fernside Addiction Recovery, McLean Hospital/Harvard Medical School, USA
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42
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Bielenberg J, Swisher G, Lembke A, Haug NA. A systematic review of stigma interventions for providers who treat patients with substance use disorders. J Subst Abuse Treat 2021; 131:108486. [PMID: 34217033 DOI: 10.1016/j.jsat.2021.108486] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stigma surrounding substance use disorders (SUDs) is a frequently cited barrier to treatment engagement. Research consistently demonstrates that healthcare professionals' attitudes towards patients with addiction problems are often negative and may adversely impact service delivery. The current study presents a systematic review of stigma interventions for providers who treat patients with SUDs, in order to evaluate the quality of existing studies and potential for implementation in clinical settings. METHODS This systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases included PubMed, APA PsycInfo and the Cochrane Database of Systematic Reviews. Of the 1462 records identified between 2011 and 2019, 15 studies were eligible for inclusion. A narrative synthesis of stigma interventions summarized the change in stigmatizing attitudes held by providers. RESULTS Studies included heterogeneous and culturally diverse samples of providers (N = 1324), who varied by age, location, discipline, and experience, with the exception of primarily female providers (75%). Results delineated six types of provider stigma interventions with components including online education, in-person education, in-person contact with consumers in recovery, or some combination of these elements. The highest quality studies incorporated motivational interviewing or communication training interventions, and many interventions combined either in-person mentorship or contact with individuals in recovery. Positive effects on provider attitudes occurred at several levels of educational and consumer contact interventions. Interventions with consumer contact demonstrated long-term maintenance of attitudinal shifts. Despite significant methodological limitations and low-quality assessment ratings, several studies utilized real-world providers and patients, as well as practical, innovative, brief, and potentially cost-effective interventions, particularly in locations with limited technological resources. CONCLUSIONS Research on provider stigma interventions increased in recent years, indicating greater worldwide attention to the negative impact of stigma. While educational interventions alone can be helpful in attitudinal change, contact with individuals in recovery from SUDs is a vital component of provider stigma interventions, particularly for lasting effects. This review highlights the importance of including implementation outcomes, such as sustainability and cost-effectiveness, in the study of stigma interventions for providers of addiction treatment.
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Affiliation(s)
- Jennifer Bielenberg
- Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
| | - Gabrielle Swisher
- Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
| | - Nancy A Haug
- Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
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Holm AL, Salemonsen E, Severinsson E. Suicide prevention strategies for older persons-An integrative review of empirical and theoretical papers. Nurs Open 2021; 8:2175-2193. [PMID: 33619899 PMCID: PMC8363358 DOI: 10.1002/nop2.789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/15/2021] [Accepted: 01/31/2021] [Indexed: 12/16/2022] Open
Abstract
AIM To synthesize suicide prevention strategies for older adults. The review question was Which suicide prevention strategies are useful for older adults? DESIGN Integrative review. DATA SOURCES Academic Search Premier, CINAHL, Ovid PsycINFO and PubMed were searched for articles published between January 2009 and December 2019. REVIEW METHODS An integrative review of quantitative, qualitative and theoretical papers with a qualitative thematic analysis. RESULTS Key aspects of the included studies contributed to the formulation of four themes: (1) Recognizing older adults' physical and/or mental health problems and referring them for help and treatment, (2) Designing an educational programme, (3) Communication and dialogue about warning signs and (4) Social support and awareness of causing significant others emotional pain. The findings indicate an urgent need to identify effective suicide prevention strategies for older adults.
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Affiliation(s)
- Anne Lise Holm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Elin Salemonsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Elisabeth Severinsson
- Nursing and Healthcare Research Group, Department of Research, Stavanger University Hospital, Stavanger, Norway
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Bojanić L, Pitman A, Kapur N. Suicide prevention through means restriction: the example of firearms control in Croatia. J Public Health (Oxf) 2021; 44:402-407. [PMID: 33429426 DOI: 10.1093/pubmed/fdaa251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/13/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Bojanić
- National Confidential Inquiry into Suicide and Safety in Mental Health, Division of Psychology and Mental Health, University of Manchester, M13 9PL, Manchester, UK
| | - A Pitman
- Division of Psychiatry, University College London, W1T 7NF, London, UK.,Camden and Islington NHS Foundation Trust, NW1 0PE, London, UK
| | - N Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Division of Psychology and Mental Health, University of Manchester, M13 9PL, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, M25 3BL, Manchester, UK
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Abstract
This chapter presents a narrative synthesis of the evidence relating to the effectiveness of 13 different approaches (interventions) that have been incorporated into national suicide prevention programs. These approaches are presented in an analytic framework that distinguishes between national and community-based multilevel programs, prevention, and treatment/maintenance. The primary source of evidence are six reviews of reviews published since 2005, supplemented by a small number of systematic reviews and primary studies. We report strongly supportive evidence concerning the effectiveness of structural interventions (restrictions on access to bridges, tall buildings, and railways) and restriction on access to pharmacological agents. Weakly supportive evidence of effectiveness is available for community-based multilevel programs; restrictions on access to firearms and ligature points in institutional settings; settings-based programs (in schools, communities, workplaces, prisons, and the armed forces); education and training targeted at primary care physicians; lithium; cognitive behavioral therapy and dialectical behavioral therapy; and brief contact. There is insufficient or conflicting evidence concerning the effectiveness of the remaining approaches. We conclude that the evidence base for effective suicide prevention is far from convincing. Major improvement in the extent and quality of collaboration between researchers, policymakers, and practitioners and a considerable increase in funding for evaluation studies in suicide prevention are required if the current knowledge gap about effective interventions is to be bridged.
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Pirkis J, Amadeo S, Beautrais A, Phillips M, Yip PSF. Suicide Prevention in the Western Pacific Region. CRISIS 2021; 41:S80-S98. [PMID: 32208763 DOI: 10.1027/0227-5910/a000670] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This chapter draws on internationally available data to describe the epidemiology of suicide and self-harm in the World Health Organization (WHO) Western Pacific Region. It then describes the suicide prevention activities in the region, using in-depth case studies to highlight some key suicide prevention activities in certain countries/areas and the Global Survey on Suicide Prevention conducted in 2013 by the International Association for Suicide Prevention (IASP) and WHO. It demonstrates that there is considerable variability both between and within low and middle income countries and high income countries, both in terms of rates of suicide and self-harm and in terms of the preventive efforts that have been mobilised to address them. Adequate funding for suicide prevention efforts in the region should be a priority, as should the delivery of a range of suicide prevention approaches. Evaluation and monitoring efforts are also crucial.
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Affiliation(s)
- Jane Pirkis
- Melbourne School of Population and Global Health, University of Melbourne, Australia.,International Association for Suicide Prevention, Washington DC, USA
| | | | - Annette Beautrais
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Michael Phillips
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Paul S F Yip
- Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR
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Diekamp B, Borentain S, Fu DJ, Murray R, Heerlein K, Zhang Q, Schüle C, Mathews M. Effect of Concomitant Benzodiazepine Use on Efficacy and Safety of Esketamine Nasal Spray in Patients with Major Depressive Disorder and Acute Suicidal Ideation or Behavior: Pooled Randomized, Controlled Trials. Neuropsychiatr Dis Treat 2021; 17:2347-2357. [PMID: 34290505 PMCID: PMC8289440 DOI: 10.2147/ndt.s314874] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The impact of benzodiazepines on the efficacy and safety of esketamine as a rapid-acting antidepressant remains unclear. MATERIALS AND METHODS Data from two identically designed, randomized double-blind studies were pooled and analyzed on a post-hoc basis. In both studies, adults with major depressive disorder with acute suicidal ideation or behavior were randomized to placebo or esketamine 84 mg nasal spray twice-weekly for 4 weeks, each with comprehensive standard-of-care (initial hospitalization and newly initiated or optimized oral antidepressant[s]). Efficacy and safety were analyzed in two groups based on whether patients used concomitant benzodiazepines, which were prohibited within 8 hours before and 4 hours after the first dose of esketamine and within 8 hours of the primary efficacy assessment at 24 hours. The primary efficacy endpoint - change from baseline to 24 hours post-first dose in Montgomery-Asberg Depression Rating Scale (MADRS) total score - was analyzed using ANCOVA. RESULTS Most patients (309/451, 68.5%) used concomitant benzodiazepines. Greater decrease in MADRS total score was observed with esketamine (mean [SD]: -16.1 [11.73]) versus placebo (-12.6 [10.56]) at 24 hours (least-squares mean difference: -3.7, 95% CI: -5.76, -1.59). The differences between the esketamine and placebo groups were clinically meaningful, irrespective of benzodiazepine use (benzodiazepine: -4.3 [-6.63, -1.89]; no benzodiazepine: -3.1 [-6.62, 0.45]). Among patients taking esketamine, change in MADRS total score was not significantly different between patients taking benzodiazepines (-15.8 [11.27]) versus those not taking benzodiazepines (-16.8 [12.82]) (least-squares mean difference: 1.1, [-2.24, 4.45]). Among esketamine-treated patients, the incidence of sedation was higher with benzodiazepine use, whereas dissociation was similar. CONCLUSION Benzodiazepines do not meaningfully affect the rapid-acting antidepressant effect of esketamine at 24 hours post-first dose among patients with MDD and acute suicidal ideation or behavior.
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Affiliation(s)
- Bettina Diekamp
- Department of Medical and Scientific Affairs, Janssen-Cilag GmbH, Neuss, Germany
| | - Stephane Borentain
- Department of Global Medical Affairs, Janssen Research & Development LLC, Titusville, NJ, USA
| | - Dong-Jing Fu
- Department of Neuroscience Clinical Development, Janssen Research & Development LLC, Titusville, NJ, USA
| | - Robert Murray
- Neuroscience Clinical Biostatistics, Janssen Research & Development LLC, Titusville, NJ, USA
| | - Kristin Heerlein
- Department of Medical and Scientific Affairs, Janssen-Cilag GmbH, Neuss, Germany
| | - Qiaoyi Zhang
- Global Market Access, Neuroscience, Janssen Global Services, LLC, Titusville, NJ, USA
| | - Cornelius Schüle
- Ludwig-Maximilians-University Munich, Clinic for Psychiatry and Psychotherapy, Munich, Germany
| | - Maju Mathews
- Department of Global Medical Affairs, Janssen Research & Development LLC, Titusville, NJ, USA
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Engaging primary care professionals in suicide prevention: A qualitative study. PLoS One 2020; 15:e0242540. [PMID: 33253178 PMCID: PMC7704003 DOI: 10.1371/journal.pone.0242540] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 11/04/2020] [Indexed: 01/06/2023] Open
Abstract
In health systems with strongly developed primary care, such as in the Netherlands, effectively engaging primary care professionals (PCPs) in suicide prevention is a key strategy. As part of the national Suicide Prevention Action Network (SUPRANET), a program was offered to PCPs in six regions in the Netherlands in 2017–2018 to more effectively engage them in suicide prevention. This implementation study aimed to evaluate to what extent SUPRANET was helpful in supporting PCPs to apply suicide prevention practices. From March to May 2018, 21 semi-structured interviews have been carried out with PCPs and other non-clinical professionals from SUPRANET regions in the Netherlands. Verbatim transcripts were analysed using the grounded theory approach. Data was structured using the Consolidated Framework for Implementation Research, which enabled identifying facilitating and challenging factors for PCPs to carry out suicide prevention practices. An important challenge included difficulties in assessing suicide risk (intervention characteristics) due to PCPs’ self-perceived incompetence, burdensomeness of suicide and limited time and heavy workload of PCPs. Another important limitation was collaboration with mental health care (outer setting), whereas mental health nurses (inner setting) and SUPRANET (implementation process) were facilitating factors for applying suicide prevention practices. With regard to SUPRANET, especially the training was positively evaluated by PCPs. PCPs expressed a strong need for improving collaboration with specialized mental health care, which was not provided by SUPRANET. Educating PCPs on suicide prevention seems beneficial, but is not sufficient to improve care for suicidal patients. Effective suicide prevention also requires improved liaison between mental health services and primary care, and should therefore be the focus of future suicide prevention strategies aimed at primary care.
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Mohatt NV, Kreisel CJ, Hoffberg AS, Mph LW, Beehler SJ. A Systematic Review of Factors Impacting Suicide Risk Among Rural Adults in the United States. J Rural Health 2020; 37:565-575. [PMID: 33210399 DOI: 10.1111/jrh.12532] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Suicide rates continue to be significantly higher in rural compared to urban communities in the United States, with the suicide rate disparity continuing to grow since 1999. This systematic review synthesizes rural-specific factors related to increased suicide risk. METHODS OVID Medline, EMBASE, OVID PsycINFO, Web of Science, SocINDEX, Cochrane Library, and Google Scholar were searched for articles published after 2003 investigating rural adult suicide in the United States. Selection criteria were: (1) study participants > 18 years old; (2) included rural participants or communities; (3) included suicidal self-directed violence outcomes; (4) within the United States; (5) published after 2003; (6) presented peer-reviewed original data; (7) identified rural-specific risk or protective factors for suicide or barriers to treatment. FINDINGS Of the 1,058 records screened, 34 studies were included. The strength of evidence was relatively stronger for individual level factors including lethal means, alcohol and substance use. CONCLUSIONS Access to firearms is strongly related to elevated rural US suicide rates, with substance use, economic stress, and behavioral health care utilization as additional individual level factors that may contribute to the disparity. At the community level, economic distress and access to care were commonly identified factors. Future research should better quantify how risk factors contribute to rural suicide and examine interdependence across social-ecological levels. Suicide prevention efforts for the rural United States must address access to lethal means, in particular the use of firearms, and navigate limited access to quality behavioral health care.
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Affiliation(s)
- Nathaniel V Mohatt
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Carlee J Kreisel
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Adam S Hoffberg
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Leah Wendleton Mph
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Sarah J Beehler
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,University of Minnesota Medical School, Duluth Campus, Duluth, Minnesota
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Prediction of Suicide-Related Events by Analyzing Electronic Medical Records from PTSD Patients with Bipolar Disorder. Brain Sci 2020; 10:brainsci10110784. [PMID: 33121080 PMCID: PMC7692143 DOI: 10.3390/brainsci10110784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Around 800,000 people worldwide die from suicide every year and it’s the 10th leading cause of death in the US. It is of great value to build a mathematic model that can accurately predict suicide especially in high-risk populations. Several different ML-based models were trained and evaluated using features obtained from electronic medical records (EMRs). The contribution of each feature was calculated to determine how it impacted the model predictions. The best-performing model was selected for analysis and decomposition. Random forest showed the best performance with true positive rates (TPR) and positive predictive values (PPV) of greater than 80%. The use of Sertraline, Fentanyl, Aripiprazole, Lamotrigine, and Tramadol were strong indicators for no SREs within one year. The use of Haloperidol, Trazodone and Citalopram, a diagnosis of autistic disorder, schizophrenic disorder, or substance use disorder at the time of a diagnosis of both PTSD and bipolar disorder, predicted the onset of SREs within one year. Additional features with potential protective or hazardous effects for SREs were identified by the model. We constructed an ML-based model that was successful in identifying patients in a subpopulation at high-risk for SREs within a year of diagnosis of both PTSD and bipolar disorder. The model also provides feature decompositions to guide mechanism studies. The validation of this model with additional EMR datasets will be of great value in resource allocation and clinical decision making.
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