The Esperance primary prevention of suicide project

Benchmarking the "Question, Persuade, Refer" Program Against Evaluations of Established Suicide Prevention Gatekeeper Trainings

Gatekeeper training is a common approach for aiding suicidal youth. This study utilizes comparative effectiveness "benchmarks" from established programs to evaluate the Question, Persuade, Refer (QPR) program. The QPR program was implemented with adults (N = 2,389) working in youth-serving community agencies. Questionnaires assessed suicide prevention knowledge, attitudes, subjective norms, perceived behavioral control, and behaviors. Consistent with benchmarked studies, participants in QPR demonstrated knowledge and suicide prevention behavior gains compared with control groups. Future research should utilize benchmarking methods as a measure of effectiveness, and more thoroughly assess mechanisms that promote behavior change.

Suicide attempt presentations at the emergency department: outcomes from a pilot study examining precipitating factors in deliberate self-harm and issues in primary care physician management

The aim of this study was to examine the psychosocial precipitating factors of people presenting to the emergency department (ED) due to attempted suicide. Demographic, diagnostic and service use data were collected for a 6-week period. All patients were referred for primary care physician (PCP) management, with a sample followed up for secondary analysis of precipitants to self-harm and follow-up outcomes. Results of the study showed that key psychosocial stressors that triggered suicidality were relationship issues and recent unemployment, with depression present in 92% of cases. While 83% of patients followed attended their first PCP appointment, 50% discontinued by 3 months. The conclusion of this study is that psychosocial crises and depression are key factors in suicide attempts. Assertive crisis intervention, facilitated linkage to community services, and greater monitoring are recommended.

The effects of the Gatekeeper Suicide-Awareness Program for nursing personnel

PURPOSE

This study evaluates whether a short training program can improve nurses' abilities to recognize and effectively respond to patients exhibiting suicidal behavior.

DESIGN AND METHODS

The study is a randomized controlled trial. Ninety-eight nurses in the experimental group attended the regular monthly continuing education class and a 90-min Gatekeeper Suicide-Awareness Program. Ninety-seven nurses in the control group only attended the regular monthly continuing education class. Before and after the different educational interventions, all the nurses were asked to complete a questionnaire to link demographic data and to access their awareness of suicide warning signs and their responses if encountering a potentially suicidal individual.

FINDINGS

Nurses who participated in the Gatekeeper Suicide-Awareness Program were much more aware of suicide warning signs and more willing to refer patients for professional counseling.

PRACTICE IMPLICATIONS

We suggest that nursing personnel's continuing education include a training program for suicide prevention.

Improvements to suicide prevention training for prison staff in England and Wales

Suicide prevention training for the prison service in England and Wales has been criticized. STORM is a package emphasizing the practice and review of interactions with suicidal persons and was evaluated in a pilot study for use in prisons. Trainees completed questionnaires immediately before and after training and at 6 to 8 months follow-up. Training significantly improved attitudes, knowledge, and confidence, and improvements were maintained at follow-up. Satisfaction with training was very high. STORM was successfully adapted for prison settings, and showed good effects among staff trained. It should be provided to the wider prison estate, with regular refresher training.

Assessing the impact of media guidelines for reporting on suicides in Austria: interrupted time series analysis

OBJECTIVE

Media guidelines for reporting on suicides are a widely used means of preventing imitative suicides, but scientific accounts of their impact on suicide numbers are sparse. This report provides an evaluation of the Austrian guidelines that were introduced in 1987 as a natural experiment.

METHODS

The impact of the guidelines was tested by applying an autoregressive integrated moving average (ARIMA) model and a linear regression model. In addition to a nationwide evaluation, Austria was divided into three areas according to regional differences in coverage rates of the collaborating newspapers and the impact of the intervention was tested for each area separately. Main outcome measures were the overall annual suicide numbers, and the numbers of Viennese subway suicides that were exceptionally newsworthy for the mass media. In order to test intermediate impacts, also quantitative and qualitative changes in media reporting after the introduction of the guidelines were analysed.

RESULTS

There was some evidence of a nationwide impact of the guidelines, calculated as a significant reduction of 81 suicides (95% confidence interval: -149 to -13; t = -2.32, df = 54, p <0.024) annually. This effect was particularly due to a significant reduction in the area with the highest coverage rates of the collaborating newspapers. Viennese subway suicides showed a highly significant level shift (t = -4.44, df = 19, p <0.001) and a highly significant trend change (t = -4.20, df = 19, p <0.001) after the introduction of the guidelines. These effects corresponded to significant changes in the quality and quantity of media reporting.

CONCLUSIONS

The present results clearly support the hypothesis that the media guidelines have had an impact on the quality of reporting as well as on suicidal behaviour in Austria, and stress the importance of collaborating with nationwide, but also with regional media to achieve efficacy. Further research is needed to provide an international insight into this public health issue.

Newspaper reporting of suicide cases in Hong Kong

This study addresses the concerns over newspapers' reporting of suicide cases in Hong Kong, SAR (Special Administrative Region), using the WHO guidelines on the reporting of suicide news as a reference for comparison. We compared the official suicide information extracted from the Coroner's Court for the year 2000 with newspaper reports on suicides taken from five major Chinese local newspapers, which accounted for about 80% of the total circulation in Hong Kong. The type of newspaper reporting on suicides was also examined. Newspapers tended to report on those suicide victims who suffered relationship problems, whereas those who had family problems were significantly underreported. Among the suicides reported in the newspapers, 6.2% were found on the front page and the majority of the reports were presented pictorially. The reporting of suicides was selective and the coverage was incomplete, with student suicides reported excessively. The method of reporting for Hong Kong newspapers was not in line with the recommendations of the WHO or international best practices on presenting suicide news. For this reason we recommend a partnership approach with active participation from the media on suicide prevention so that communication professionals can proactively participate in suicide prevention work more effectively.

The effect of recalling paracetamol on hospital admissions for poisoning in Western Australia

OBJECTIVES

To assess the effect of two recalls of paracetamol products on rates of intentional and unintentional overdoses of paracetamol in all age groups, as well as any effect on poisoning by other agents.

DESIGN

A before-and-after epidemiological study using data from the Western Australian Health Services Research Linked Database, which records all admissions to public and private hospitals throughout the State.

MAIN OUTCOME MEASURES

Hospital admissions in Western Australia for poisonings with all agents, including paracetamol and other over-the-counter analgesics.

RESULTS

There were 11 752 admissions for poisoning from 1996 to 2001. Paracetamol was the primary poisoning agent in 2266 (19.3%) admissions, aspirin in 120 (1%) and ibuprofen in 277 (2%). There was a significant decrease in the admission rate for paracetamol poisoning when sales were restricted in 2000 (rate ratio, 0.82; 95% CI, 0.68-0.99) compared with the same period in other years. There was no increase in poisoning with other agents at this time. However, admissions for paracetamol overdose also showed a large random variation that tended to obscure any effect.

CONCLUSIONS

Our study highlights the need to control for random as well as seasonal fluctuations in admission rates, and for restrictions on paracetamol sales to last for several months across all retail outlets. Limiting access to paracetamol may reduce paracetamol poisonings without a coincident increase in the use of other agents