Suicide literacy and suicide stigma - results of a population survey from Germany

Suicide awareness homophily in adolescent peer support networks: A Swiss cross-sectional social network analysis

Objective

Suicide awareness, encompassing knowledge, attitudes, and behaviors related to suicide, plays a critical role in primary suicide prevention, especially among adolescents. However, little is known about how perceived suicide awareness is apparent in peer support networks in this population. This study examined the presence of suicide awareness homophily in adolescent peer support networks. We also explored other patterns of homophily and identified factors associated with the in-degree popularity of adolescents.

Methods

We used baseline data from a non-randomized, cluster-controlled trial assessing the effectiveness of a universal suicide prevention intervention in Swiss secondary schools (n = 194). We assessed perceived suicide awareness, support networks (including in-degree popularity, i.e., receiving a high number of nominations as a supportive peer), and other covariates. Data were analyzed using social network analyses.

Results

We found evidence of suicide awareness homophily in peer support networks, where adolescents with high suicide awareness were more likely to connect with peers having high suicide awareness (p < .001). The same applied to those with low suicide awareness (p < .001). Age also emerged as a significant homophily factor. Girls (p = .024) and adolescents with high instrumental social support (p = .008) were more likely to be popular in peer support networks.

Conclusions

This study highlighted the homophily of suicide awareness in peer support networks and the need to focus on strengthening peer support networks and promoting suicide awareness in adolescents, particularly for those with low suicide awareness. Future suicide prevention programs, including peer-led interventions, should consider these findings to better target vulnerable subgroups and reduce suicide-related disparities.

Education and suicidal ideation in Europe: A systematic review and meta-analysis

BACKGROUND

Understanding predictors of suicidal ideation (SI) is crucial for preventing suicides. Given Europe's high suicide rates and the complex nature of SI, it is essential to also examine social determinants like education as potential risk factors for SI in this region. This systematic review and meta-analysis investigates the association between formal/vocational education and SI in Europe.

METHODS

Electronic databases (PubMed, Web of Science, PsycINFO, PSYNDEX) were searched until November 2022. Included studies involved European populations examining associations between education and SI. Pooled Odds Ratios (OR) with 95 % confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed with the heterogeneity variance τ2 and I2 statistic; subgroup analyses were performed based on study characteristics. Risk of bias was assessed using an adaption of the Newcastle-Ottawa Scale.

RESULTS

From 20,564 initial studies, 41 were included in the meta-analysis (outlier-adjusted, 96,809 study participants). A negative, insignificant association (OR = 0.86, 95 % CI: 0.75; 1.00) was observed between education and SI, with significant heterogeneity (τ2 = 0.09, I2 = 73 %). Subgroup analyses indicated that population type, age group, categorization of education, timeframe of SI assessment, and study quality significantly moderated the effect size.

LIMITATIONS

Heterogeneity across studies limits generalizability. The cross-sectional design precludes establishing causal relationships, and social desirability bias may have underestimated the association between education and SI.

CONCLUSIONS

This systematic review and meta-analysis suggests a trend towards a protective effect of education on the emergence of SI in Europe. Future research, preferably with longitudinal study design examining various covariates, should systematically consider educational inequalities in SI.

A survey of suicide literacy in Japanese school teachers

School teachers are in a unique position to recognize suicide-related problems in their students and to appropriately support them; teachers may need high levels of suicide literacy. However, few studies have examined current levels of suicide literacy in teachers. This study aimed to investigate suicide literacy in school teachers. Teachers (n = 857) from 48 Japanese schools (primary and junior-/senior-high) answered a self-administered questionnaire assessing (a) knowledge about suicide, (b) intention to ask about students' suicidal thoughts/plans, and (c) attitudes towards talking to students with mental health problems. The average proportion of correct answers to the knowledge questions (10 items) was 55.2%. Over half of the teachers knew that suicide is a leading cause of death in adolescents (55.0%), and that asking about suicidality is needed (56.2%). Half of the teachers intended to ask students about their suicidal thoughts (50.2%) and fewer intended to ask about experiences of planning suicide (38.8%). Most of the teachers (90.4%) agreed with the idea that talking to students with mental health problems was a teacher's responsibility. Intention to ask about students' suicidal thoughts/plans were higher in teachers in their 20s (vs. 40s-60s) and working at junior-/senior-high schools (vs. primary schools). Suicide literacy in Japanese school teachers was observed to be limited. However, teachers felt responsibility for helping students with mental health problems. The development and implementation of education programs may help improve teachers' suicide literacy, which, in turn, could encourage effective helping behaviors of teachers for students struggling with suicidality.

Suicide literacy mediates the path from religiosity to suicide stigma among Muslim community adults: Cross-sectional data from four Arab countries

BACKGROUND

The majority of research attention has been devoted to the link between religiosity and suicide risk, and a considerable amount of studies has been carried out on how stigma impacts individuals with mental health problems of different kinds. However, the interplay between religiosity, suicide literacy and suicide stigma has seldom been empirically researched, especially quantitatively. We sought through this study to redress the imbalance of research attention by examining the relationship between religiosity and suicide stigma; and the indirect and moderating effects of suicide literacy on this relationship.

METHOD

A cross-sectional web-based survey was conducted among Arab-Muslim adults originating from four Arab countries (Egypt: N = 1029, Kuwait: N = 2182, Lebanon N = 781, Tunisia N = 2343; Total sample: N = 6335). The outcome measures included the Arabic Religiosity Scale which taps into variation in the degree of religiosity, the Stigma of Suicide Scale-short form to the solicit degree of stigma related to suicide, and the Literacy of Suicide Scale explores knowledge and understanding of suicide.

RESULTS

Our Mediation analyses findings showed that literacy of suicide partially mediated the association between religiosity and stigmatizing attitude toward suicide. Higher religiosity was significantly associated with less literacy of suicide; higher literacy of suicide was significantly associated with less stigma of suicide. Finally, higher religiosity was directly and significantly associated with more stigmatization attitude toward suicide.

CONCLUSION

We contribute the literature by showing, for the first time, that suicide literacy plays a mediating role in the association between religiosity and suicide stigma in a sample of Arab-Muslim community adults. This preliminarily suggests that the effects of religiosity on suicide stigma can be modifiable through improving suicide literacy. This implies that interventions targeting highly religious individuals should pay dual attention to increasing suicide literacy and lowering suicide stigma.

Evaluation the validity and reliability of persian short form of the literacy of suicide scale (LOSS): a methodological study in 2022

INTRODUCTION

This research was conducted with the aim of evaluating the validity and reliability of Persian short version of the Literacy of Suicide Scale (LOSS) among the general population.

METHODS

This methodological study was conducted to evaluate the validity and reliability of Persian short form of LOSS among the general population, using a sample of 1175 participants in Iran, 2022. Participants were entered to study using method of proportional stratified sampling. The validity of Persian short form of LOSS was checked by four measures of validity: qualitative face validity, qualitative content validity, EFA (exploratory of factor analysis), and CFA (confirmatory factor analysis). The measure of reliability of Persian short form of LOSS was checked by three reliability of McDonald omega coefficient, ICC (Intraclass Correlation Coefficient), and Cronbach's alpha coefficient.

RESULTS

Based on the findings of EFA, 4 components with eigenvalues > 1 were extracted and these 4 factors were able to explain 57.96% of variance. In EFA section, only 1 question was deleted due to entry into the non -relevant sub -scale. Based on the results of CFA, all items had the factor loading greater than 0.4 and none of the items were removed at this stage. In CFA, based the results of goodness-of-fit indexes for example: χ2/df = 2.077, NFI: 0.957, IFI = 0.977, RMSEA = 0.030, GFI: 0.988, and PGFI = 0.569, the final mode was approved with 11 items and 4 factors. In this study for all items, Cronbach's alpha coefficient was 0.739, McDonald omega coefficient was 0.753, and ICC was 0.860. Finally, the Persian short form of LOSS was approved with 11 items and four dimensions of signs/ symptoms with 3 questions, the risk factors with 2 questions, treatment/ prevention with 2 questions, and causes/ triggers with 4 questions.

CONCLUSION

The Persian short form of LOSS with 11 items and four subscales is a valid and reliable scale to survey the suicide literacy status in the general population.

Suicide stigma and suicide literacy among Bangladeshi young adults: a cross-sectional study

Introduction

Suicide is one of the leading causes of death worldwide. Owing to poor suicide literacy, people are not aware of the consequences of the suicide stigma, which may affect individuals. This study aimed to examine the status of suicide stigma and literacy among young adults in Bangladesh.

Methods

This cross-sectional study included 616 male subjects and female subjects residing in Bangladesh aged between 18 and 35 years who were invited to complete an online survey. Suicide literacy and suicide stigma among the respondents were assessed by using the validated Literacy of Suicide Scale and Stigma of Suicide Scale, respectively. Other independent variables that have been found to affect suicide stigma or literacy were included in this study based on prior research. Correlation analysis was used to assess the relationships between the study's main quantitative variables. Multiple linear regression models were used to assess factors affecting suicide stigma and suicide literacy, respectively, after controlling for covariates.

Results

The mean literacy score was 3.86. The participants' mean scores in the stigma, isolation, and glorification subscale were 25.15, 14.48, and 9.04, respectively. Suicide literacy was negatively associated with stigmatizing attitudes (p = 0.005). Male subjects, unmarried/divorced/widowed, less educated (below HSC), smokers, less exposure to suicide, and respondents with chronic mental illness had lower suicide literacy and more stigmatizing attitudes.

Conclusion

The findings suggest that addressing suicide literacy and stigma by developing and executing awareness programs on suicide and mental health among young adults may increase knowledge, decrease stigma, and hence prevent suicide among this population.

Title page: psychometric properties of literacy of suicide scale (LOSS) in iranian population: long form

INTRODUCTION

Suicide and suicide attempts are among the most important indicators of mental health in the world. In this research, the validity and reliability of Literacy of Suicide Scale (LOSS) was examined in general people over the age of 18.

METHODS

This cross-sectional psychometric study was conducted in 2022 among 952 general population in Iran. Participants were selected by two methods of proportional stratified sampling and simple random sampling. The internal consistency of the tools was assessed using Cronbach's alpha coefficient, and McDonald omega coefficient. Also, test-retest reliability was checked by Intraclass Correlation Coefficient (ICC).

RESULTS

In the confirmatory factor analysis section, the factor loading of all questions were above 0.4 and one questions were deleted and final model with four factors and 25 questions was confirmed (Some of goodness-of-fit indexes: AGFI = 0.910, RMSEA = 0.050, IFI = 0.901, and χ2/df = 3.333). For all questions, the Cronbach's alpha coefficient was 0.859, McDonald omega coefficient was 0.866, and ICC was 0.895. Finally, the Persian long version of LOSS was approved with 25 items and four subscales: causes/triggers (9 items), risk factors (7 items), signs and symptoms (5 items) and treatment/prevention (4 items).

CONCLUSION

The Persian long version of LOSS with four subscales and 25 items is an appropriate tool to investigate the state of suicide literacy in the public population.

Exploring Sociodemographic Correlates of Suicide Stigma in Australia: Baseline Cross-Sectional Survey Findings from the Life-Span Suicide Prevention Trial Studies

The risk of suicidal behaviour in Australia varies by age, sex, sexual preference and Indigenous status. Suicide stigma is known to affect suicide rates and help-seeking for suicidal crises. The aim of this study was to investigate the sociodemographic correlates of suicide stigma to assist in prevention efforts. We surveyed community members and individuals who had attended specific emergency departments for suicidal crisis. The respondents were part of a large-scale suicide prevention trial in New South Wales, Australia. The data collected included demographic characteristics, measures of help-seeking and suicide stigma. The linear regression analyses conducted sought to identify the factors associated with suicide stigma. The 5426 participants were predominantly female (71.4%) with a mean (SD) age of 41.7 (14.8) years, and 3.9% were Indigenous. Around one-third of participants reported a previous suicide attempt (n = 1690, 31.5%) with two-thirds (n = 3545, 65.3%) seeking help for suicidal crisis in the past year. Higher stigma scores were associated with Indigenous status (β 0.123, 95%CI 0.074-0.172), male sex (β 0.527, 95%CI 0.375-0.626) and regional residence (β 0.079, 95%CI 0.015-0.143). Lower stigma scores were associated with younger age (β -0.002, 95%CI -0.004--0.001), mental illness (β -0.095, 95%CI -0.139 to -0.050), male bisexuality (β -0.202, 95%CI -0.351 to -0.052) and males who glorified suicide (β -0.075, 95%CI -0.119 to -0.031). These results suggested that suicide stigma differed across the community, varying significantly by sex, sexual orientation and Indigenous status. Targeted educational programs to address suicide stigma could assist in suicide prevention efforts.

Level and Associated Factors of Literacy and Stigma of Suicide among Bangladeshi Physicians: A Cross-Sectional Assessment

Objectives. Literacy and stigma of suicide among doctors affect health-service delivery for persons with suicidal behavior. However, no attempt has been identified to assess those among physicians in Bangladesh. We aimed to determine the level and associated factors of suicide literacy and stigma toward suicide among physicians in Bangladesh. Methods. We collected data from 203 physicians in February 2022 by Google Forms. We used the Bangla literacy of suicide scale (LOSS-B) and the Bangla stigma of suicide scale (SOSS-B) to assess the literacy and stigma of suicide. The instrument also included questions for collecting sociodemographic variables and assessing suicidal behavior. Results. The mean age of the physicians was $34.17\pm 7.86$ (range 23–66) years, 109 (53.7%) were females, 150 (73.9%) were married, and 181 (89.2%) were Muslim. The mean LOSS-B score was $5.9\pm 1.96$ (range 1-10). Suicide literacy was higher in singles ( $p=0.013$ ), doctors with a family history of suicide ( $p=0.018$ ), a history of suicidal thought in lifetime ( $p\le 0.001$ ), and in the last year ( $p=0.03$ ). Muslims ( $p=0.017$ ) and city dwellers ( $p=0.021$ ) had higher scores in the stigma subscale of SOSS-B whilst respondents with history of mental illness had a significantly lower level of stigma ( $p\le 0.006$ ). The stigma and isolation subscales were positively correlated indicating a higher value stigma creates higher isolation ( $p\le 0.001$ ). No relationship between suicide literacy and suicide stigma was identified among the physicians. Conclusions. Suicide literacy among the physicians of Bangladesh is low albeit higher than the level among the students. Appropriate programs should be designed to improve the status quo because physicians play fundamental roles as health-service providers as well as gatekeepers in suicide prevention.

Two sides of the same coin? The association between suicide stigma and suicide normalisation

AIMS

Evidence suggests that suicide stigma (i.e. negative attitudes towards persons affected by suicide/suicidality) and suicide normalisation (i.e. liberal attitudes towards suicide) are both associated with increased suicide risk. Despite conceptual similarities and potential interaction, suicide stigma and suicide normalisation have usually been investigated separately. We used cross-sectional data from a community sample to test the association between suicide stigma and suicide normalisation as well as to identify their respective determinants and consequences.

METHODS

Participants were N = 3.269 adults recruited from an established online-panel using quotas to reflect the composition of the German general population with regard to age, gender, education and region. We collected information about suicide stigma, suicide normalisation, intentions to seek help for suicidality, current suicidality, suicide literacy, negative mood and socio-demographic variables. We used regression modelling to determine the association between suicide stigma and suicide normalisation as well as to identify their determinants and consequences.

RESULTS

Suicide stigma and suicide normalisation were inversely associated so that higher suicide stigma scores were linked to lower suicide normalisation. More suicide stigma was associated with reduced intentions to seeking professional help, increased willingness to seek help from family and friends and lower odds to experience current suicidality, however the association between suicide stigma and intentions to seek professional help diminished after controlling for confounding variables. Increased suicide normalisation was linked to reduced intentions to seek help from professionals or family and friends, as well as higher odds to experience current suicidality, even after controlling for confounding variables.

CONCLUSIONS

Our findings suggest that interventions to reduce public suicide stigma are at risk to unintentionally increase suicide normalisation, which appears to be a key barrier to seeking help for suicidality. Future research should therefore identify strategies to improve attitudes towards persons affected by suicidality that avoid normalisation, i.e. do not convey the message of suicide as an acceptable solution for difficult life situations. One strategy with great potential to safely reduce public suicide sigma could be interventions that stimulate interpersonal contact with affected persons sharing their recovery story.

The Malay Literacy of Suicide Scale: A Rasch Model Validation and Its Correlation with Mental Health Literacy among Malaysian Parents, Caregivers and Teachers

The 27-item Literacy of Suicide Scale (LOSS) is a test designed to measure the respondent’s suicide knowledge. The purpose of this study is to examine the psychometric properties of the Malay-translated version of the LOSS (M-LOSS) and its association to sociodemographic factors and mental health literacy. The 27-item LOSS was forward–backward translated into Malay, and the content and face validities were assessed. The version was distributed to 750 respondents across West Malaysia. Rasch model analysis was then conducted to assess the scale’s psychometric properties. The validated M-LOSS and the Malay version of the Mental Health Knowledge Schedule (MAKS-M) were then distributed to 867 respondents to evaluate their level of suicide literacy, mental health literacy, and their correlation. Upon Rasch analysis, 26 items were retained. The scale was found to be unidimensional, with generally satisfying separation and reliability indexes. Sex, socio-economic status, and experience in mental health were found to significantly impact the mean score for mental health literacy. This study also found a significant mean difference for suicide literacy across school types. Furthermore, while this study observed a weak but significant negative correlation between age and suicide literacy, no correlation was found between mental health and suicide literacy.

[Development of an online intervention on suicidality-providing knowledge and reducing suicide stigma]

Bei Suizidalität können die Angst, von anderen stigmatisiert zu werden, sowie Selbststigmatisierung und unzureichende Informationen dazu führen, dass Hilfsangebote weniger oder gar nicht in Anspruch genommen werden. E‑Mental-Health-Interventionen sind eine Möglichkeit, niederschwellig viele Betroffene über die Thematik zu informieren und auf persönliche Hilfsangebote vorzubereiten. Am Universitätsklinikum Hamburg-Eppendorf wurde eine komplexe Intervention entwickelt, gefördert im Rahmen des Förderschwerpunkts „Suizidprävention (A: Entstigmatisierung)“ des Bundesministeriums für Gesundheit. Entwicklung und Inhalte dieser Onlineintervention sollen im vorliegenden Beitrag beschrieben werden.

Nach einer repräsentativen Telefonbefragung der deutschen Allgemeinbevölkerung, mit der Wissenslücken und Stigmatisierungstendenzen zum Thema Suizid untersucht wurden, entstand auf Basis eines australischen Suizidpräventionsprojekts und in Zusammenarbeit mit Betroffenen und Angehörigen die Onlineintervention „8 Leben – Erfahrungsberichte und Wissenswertes zum Thema Suizid“. Darin wurden sowohl wissenschaftlich-klinische Fakten rund um das Thema Suizidalität als auch eine gesellschaftlich-kulturelle Perspektive beleuchtet sowie auf Selbsthilfemöglichkeiten und professionelle Hilfsangebote verwiesen. Es wurden Videoerfahrungsberichte von Betroffenen und Angehörigen gezeigt. Aktuell wird das Projekt ausgewertet. Eine Weiterführung ist geplant.

In der Intervention werden verschiedene Sichtweisen gezeigt und die Personen, die die Intervention in Anspruch nehmen, werden sowohl auf kognitiver als auch auf emotionaler Ebene angesprochen. Aufgrund der Prävalenz von Suizidalität und der dennoch bestehenden Tabuisierung des Themas scheinen seriöse, evidenzbasierte und niedrigschwellige Präventions- und Informationsangebote besonders relevant.

Development of an online suicide prevention program involving people with lived experience: ideas and challenges

BACKGROUND

Fear of stigmatization, self-stigmatization, and insufficient information can lead to secrecy, reduced help-seeking, lower self-esteem, and lower self-efficacy among people affected by suicidality or suicide. Therefore, we developed an online suicide prevention program aiming to improve knowledge about suicidality and suicide stigma.

METHODS

Inspired by the Australian program The Ripple Effect, a German team comprising people with lived experience of suicide, researchers, and clinicians was established for developing an online suicide prevention program. Therefore, we oriented on guidelines for evidence-based health information, for reporting on suicide, and on dealing with suicidality. The lived experience team discussed and developed concept, structure, and content of the program. This manuscript presents summaries of protocols from 16 team meetings and 3 written text reviews to outline the program development process. A summative evaluation 3 years after program development began was qualitatively analyzed based on thematic analysis.

RESULTS

Between 2018 und 2021, the lived experience team (n = 10) discussed possibilities of support in suicidal crises, attitudes towards suicide, content, and design of the online program. In a structured process, six members of the lived experience team reviewed the content. Eight persons shared their lived experience of suicide in video reports by focusing on constructive ways of dealing with suicidality or a loss by suicide, conveying hope and encouraging people to continue living. Team members recommended greater public and patient involvement from the application stage, as well as more financial and personnel resources.

CONCLUSIONS

Through contributions to discussions and text reviews, the lived experience team shaped decisions in the program development process. While involving persons with lived experiences of suicide, it is important to consider that suicidality is 1. emotionally challenging, 2. a stigmatized issue, and 3. that the aspect of safety must be a priority. A distinction must be made between the duty of care based on actual risk and inappropriate overprotection. Hereby, transparency, autonomy, and a clear structure appeared to be helpful. For further research, we recommend a structured formative review process of the development of the program. Additionally, we recommend discussing the purpose and the specific design of the evaluation with a lived experience team in advance. Trial registration German Clinical Trial RegisterDRKS00015071 on August 6, 2018.