Understanding Suicide Clusters Through Exploring Self-Harm Behaviors

Background: There is little information about characteristics and long-term outcomes of individuals who self-harm during a suicide cluster. Aims: To compare characteristics of individuals who self-harmed during a suicide cluster in South Wales (∼10 deaths between December 2007 and March 2008) with others who self-harmed prior to the cluster and to evaluate 10-year self-harm and mortality outcomes. Method: Using records from the hospital serving the catchment area of the suicide cluster, enhanced by national routinely collected linked data, we created the following two groups: individuals who self-harmed (a) during the suicide cluster and (b) 1 year before. We compared individuals' characteristics and performed logistic regression to compute odds ratios of 10-year self-harm and mortality outcomes. Results: Individuals who self-harmed during the cluster were less likely to be hospitalized or have a mental health history than those who self-harmed prior to the cluster. No significant group differences were found for 10-year self-harm outcomes, but all-cause mortality was higher for males. Limitations: Sample size was small, and data were lacking on psychological and social proximity to individuals who died during the suicide cluster. Conclusion: Our findings highlight the importance of long-term healthcare follow-up of those who self-harm during a suicide cluster, particularly males.

Secular trends of suicide risk for residents in mainland China (2004 to 2019): An updated age-period-cohort analysis

BACKGROUND

The overall suicide rate in China has dropped substantially since the 1990s, but a slowdown in the decrease and even a reversing trend was observed in specific groups in recent years. This study aims to investigate the latest suicide risk in mainland China by using the age-period-cohort (APC) analysis.

METHOD

This population-based multiyear cross-sectional study included Chinese ages 10 to 84 years using data from the China Health Statistical Yearbook (2005-2020). Data were analyzed by the APC analysis and intrinsic estimator (IE) technique.

RESULTS

The data satisfactorily fit the constructed APC models. The cohort effect indicated a high risk of suicide among people birth in 1920-1944 and a sharp decline in the 1945-1979 cohort. The lowest risk occurred in the 1980-1994 cohort before a sharp increase in generation Z (birth years in 1995-2009). The period effect showed a declining trend since 2004. The age effect indicated that the suicide risk increased over time, except for a gradual decline from age 35 to 49. The suicide risk increased greatly in adolescents and reached the highest among the elderly.

LIMITATIONS

The aggregated population-level data and the non-identifiability of the APC model could result in bias in the accuracy of results in this study.

CONCLUSIONS

This study successfully updated the Chinese suicide risk from the age, period and cohort perspective using the latest available data (2004-2019). The findings enhance the understanding of suicide epidemiology and provide evidence supporting policies and strategies at the macro-level for suicide prevention and management. Immediate action is needed to focus on a national suicide prevention strategy that targets generation Z, adolescents and the elderly which will require a collaborative effort by government officials, public/community health planners and health care agencies.

Social Media Sentiments on Suicides at the New York City Landmark, Vessel: A Twitter Study

Vessel is a landmark created by Heatherwick Studio where visitors can enjoy views of New York City from different heights and perspectives. However, between February 2020 and July 2021, four individuals jumped to their deaths from the landmark. Effective preventive solutions have yet to be identified, and the site is currently closed. In this study, we examined the trajectory of public sentiment on the suicide-related activity at Vessel on Twitter by investigating the engagement patterns and identifying themes about the four suicides from February 2020 to August 2021 (n = 3058 tweets). The results show increased levels of discussion about each successive suicide case in the first 14 days following each incident (from 6 daily tweets for the first case to 104 for the fourth case). It also took longer for relevant discussions to dissipate (4 days for the first and 14 days for the fourth case, KS statistic = 0.71, p < 0.001). Thematic analysis shows a shift from expressions of emotion to urging suicide prevention actions in the third and fourth cases; additionally, we detected growing support for restricting means. We suggest that, prior to the reopening of Vessel, collective efforts should be made to install safety protections and reduce further suicide risks.

Understanding suicide clusters through exploring self-harm: Semi-structured interviews with individuals presenting with near-fatal self-harm during a suicide cluster

There was a highly publicised cluster of at least ten suicides in South Wales, United Kingdom, in 2007-2008. We carried out a qualitative descriptive study using cross-case thematic analysis to investigate the experiences and narratives of eight individuals who lived in the area where the cluster occurred and who survived an episode of near-fatal self-harm at the time of the cluster. Interviews were conducted from 01.01.2015 to 31.12.2015. All interviewees denied that the other deaths in the area had affected their own suicidal behaviour. However, in other sections of the interviews they spoke about the cluster contributing to difficulties they were experiencing at the time, including damage to social relationships, feelings of loss and being out of control. When asked about support, the interviewees emphasized the importance of counselling, which they would have found helpful but in most cases did not receive, even in the case of close contacts of individuals who had died. The findings suggest that effective prevention messaging must be subtle, since those affected may not be explicitly aware of or acknowledge the imitative aspects of their behaviour. This could be related to stigma attached to suicidal behaviour in a cluster context. Lessons for prevention include changing the message from asking if people 'have been affected by' the suicide deaths to emphasising the preventability of suicide, and directly reaching out to individuals rather than relying on people to come forward.

Can a social media intervention improve online communication about suicide? A feasibility study examining the acceptability and potential impact of the #chatsafe campaign

There is a need for effective and youth-friendly approaches to suicide prevention, and social media presents a unique opportunity to reach young people. Although there is some evidence to support the delivery of population-wide suicide prevention campaigns, little is known about their capacity to change behaviour, particularly among young people and in the context of social media. Even less is known about the safety and feasibility of using social media for the purpose of suicide prevention. Based on the #chatsafe guidelines, this study examines the acceptability, safety and feasibility of a co-designed social media campaign. It also examines its impact on young people's willingness to intervene against suicide and their perceived self-efficacy, confidence and safety when communicating on social media platforms about suicide. A sample of 189 young people aged 16-25 years completed three questionnaires across a 20-week period (4 weeks pre-intervention, immediately post-intervention, and at 4-week follow up). The intervention took the form of a 12-week social media campaign delivered to participants via direct message. Participants reported finding the intervention acceptable and they also reported improvements in their willingness to intervene against suicide, and their perceived self-efficacy, confidence and safety when communicating on social media about suicide. Findings from this study present a promising picture for the acceptability and potential impact of a universal suicide prevention campaign delivered through social media, and suggest that it can be safe to utilize social media for the purpose of suicide prevention.

It's good to talk, but it matters how we do it'

Rosie Allister explains that although talking about suicide can be a good thing and can create opportunities to help, it must be done in a responsible way so that it doesn't cause further harm.

Troubling content: Guiding discussion of death by suicide on social media

Growing concerns about "online harm" and "duty of care" fuel debate about how best to regulate and moderate "troubling content" on social media. This has become a pressing issue in relation to the potential application of media guidelines to online discussion of death by suicide-discussion which is troubling because it is often transgressive and contested. Drawing on an innovative mixed-method analysis of a large-scale Twitter dataset, this article explores in depth, for the first time, the complexities of applying existing media guidelines on reporting death by suicide to online contexts. By focusing on five highly publicised deaths, it illustrates the limits of this translation but also the significance of empathy (its presence and absence) in online accounts of these deaths. The multi-relational and politicised nature of empathy, and the polarised nature of Twitter debate, suggests that we need to step back from calls for the automatic application of guidelines produced in a pre-digital time to understand more about the sociocultural context of how suicide is discussed on social media. This stepping back matters because social media is now a key part of how lives and deaths are deemed grievable and deserving of our attention.