Confidence and Intentions to Help a Person at Risk of Suicide

Intentions to Help People at Risk of Suicide and Associated Factors: A National Telephone Survey in Taiwan

OBJECTIVE

Many people at risk of suicide do not actively seek help. Suicide prevention efforts need to involve the general public to provide appropriate support to those in need. It is important to investigate the intention to help those at risk of suicide and the factors associated with helping intentions in the general population. We aimed to assess the intention to help people at risk and associated factors using a national representative sample.

METHOD

We conducted a national telephone survey of 1,087 Taiwanese adults and collected data regarding participants' socio-demographic characteristics, mental health status, helping intentions, misconceptions about suicide, and attitudes toward suicide and suicide prevention.

RESULTS

The prevalence of high intentions to help people at risk of suicide was 56.5%. Helping intentions did not differ by sex, educational level, employment status, marital status, or mental health status. Those with high helping intentions were younger, less likely to have misconceptions about suicide or agree that suicide is a personal choice, and more likely to believe that suicide is preventable and support suicide prevention measures.

CONCLUSIONS

Suicide prevention education programs aimed to enhance helping intentions may usefully target debunking misconceptions about suicide and cultivating positive attitudes toward suicide prevention.

Reporting Ethical Procedures in Suicide Prevention Research: Current Status and Recommendations

OBJECTIVE

Ethical concerns frequently arise in suicide prevention research regarding participant safety and confidentiality. Despite a substantial literature on managing and navigating ethical concerns in suicide research, little attention has been paid to the reporting of ethical procedures. Furthermore, standard procedures for reporting ethical risk management procedures have not been developed.

METHOD

A review of the current literature was performed to examine the current state of reporting of ethical procedures within suicide research. Articles published in 2020 (N = 263) from three suicide-focused publications were screened and then coded (n = 131) to identify reporting of procedures for the ethical conduct of research and suicide risk management steps taken by the research teams.

RESULTS

The majority of articles reported ethical review or approval (84.7%) and reported the use of an informed consent process (77.9%). Only 28.2% included risk mitigation procedures. Of those 29.7% of those articles reported conducting risk evaluation, 66.7% reported resource dissemination, and 51.4% reported an intervention.

CONCLUSION

As empirical support for brief interventions accrues, suicide prevention researchers should consider establishing standards for the reporting of procedures to ensure the safety of participants with suicidal risk.HighlightsReporting suicide safety protocols helps ensure high ethical standards in research.Fewer than 1/3 of articles reviewed reported risk mitigation procedures in 2020.Standard procedures for reporting safety protocols in suicide research are needed.

Exploring Community-Based Suicide Prevention in the Context of Rural Australia: A Qualitative Study

Suicide rates in rural communities are higher than in urban areas, and communities play a crucial role in suicide prevention. This study explores community-based suicide prevention using a qualitative research design. Semi-structured interviews and focus groups asked participants to explore community-based suicide prevention in the context of rural Australia. Participants recruited ((n = 37; ages 29-72, Mean = 46, SD = 9.56); female 62.2%; lived experience 48.6%) were self-identified experts, working in rural community-based suicide prevention (community services, program providers, research, and policy development) around Australia. Data were thematically analysed, identifying three themes relating to community-based suicide prevention: (i) Community led initiatives; (ii) Meeting community needs; and (iii) Programs to improve health and suicidality. Implementing community-based suicide prevention needs community-level engagement and partnerships, including with community leaders; gatekeepers; community members; people with lived experience; services; and professionals, to "get stuff done". Available resources and social capital are utilised, with co-created interventions reflecting diverse lifestyles, beliefs, norms, and cultures. The definition of "community", community needs, issues, and solutions need to be identified by communities themselves. Primarily non-clinical programs address determinants of health and suicidality and increase community awareness of suicide and its prevention, and the capacity to recognise and support people at risk. This study shows how community-based suicide prevention presents as a social innovation approach, seeing suicide as a social phenomenon, with community-based programs as the potential driver of social change, equipping communities with the "know how" to implement, monitor, and adjust community-based programs to fit community needs.

Intervening to prevent suicide at railway locations: findings from a qualitative study with front-line staff and rail commuters

BACKGROUND

For every suicide on the British railway network, at least six potential attempts are interrupted by front-line staff or rail commuters. However, the factors that maximise or hinder the likelihood and effectiveness of such interventions are poorly understood.

AIMS

The aim of the current study was to shed light on the experience of intervening to prevent a suicide at a railway location, including how and why people intervene, and their feelings and reflections in the aftermath.

METHOD

In-depth interviews were carried out with rail commuters (n = 11) and front-line railway staff (n = 10) who had intervened to stop a suicide by train. Data were analysed thematically.

RESULTS

Participants had intervened to prevent suicide in several ways, both from afar (e.g. by calling a member of staff) and more directly (verbally or non-verbally), in some cases with no prior training or experience in suicide prevention, and often as a 'quick, gut reaction' given the limited time to intervene. In more 'reasoned' interventions, poor confidence and concerns around safety were the greatest barriers to action. Although often privy to their final outcome, most participants reflected positively on their intervention/s, stressing the importance of training and teamwork, as well as small talk and non-judgemental listening.

CONCLUSIONS

Suicides in railway environments can present bystanders with little time to intervene. Potential interveners should therefore be resourced as best as possible through clear infrastructure help/emergency points, visibility of station staff and training for gatekeepers.

Uncovering Blind Spots in the Intention to Provide Adequate Help to Suicidal Individuals

Background: An adequate reaction from families, friends, and colleagues who can provide help to suicidal individuals is a preventive factor. Despite the logical assumption that the mere presence of risk factors in individuals needing help may affect others' helping intentions, empirical evidence is lacking in this regard. Method: We tested whether the presence of various risk factors influences the intention to provide help to suicidal individuals. Individuals (N = 890) were exposed to a vignette in which they were asked to imagine meeting a distant acquaintance. Such persons talk about serious problems and suddenly use the word "suicide." In a one-factorial between-subjects design with 21 groups, we manipulated person-related attributes corresponding to risk factors for suicide. Results: Some attributes increased helping intentions: male gender, very young and old age, homosexuality and transsexuality, terminal illness, previous nonsuicidal self-injury, previous suicide attempt, and seeking out lethal means. However, some attributes did not: female gender, major depression, chronic pain, different stressful life events, previously experienced violence, a family history of suicide, and a cry for help. Limitations: We measured self-reported behavioral intentions. Conclusions: Although people seem to adapt their helping intentions in response to some attributes, there seem to be many blind spots.

['Dites Je Suis Là', a platform to guide the relatives of suicidal people]

The purpose of the 'Dites Je Suis Là' platform is to disseminate a simple, clear and scientifically validated message to the general public to raise awareness of the warning signs of suicide. This awareness-raising campaign complements the existing support systems for suicidal people. Their loved ones can find tools for understanding and questioning their potential as caregivers. If they are willing to support a person in pain, six steps guide them in how to act to prevent suicide. Lifting the taboo around suicidal thoughts, encouraging the use of help and care, and maintaining a sincere and warm relationship are among the key elements.

Effects of the Mental Health First Aid for the suicidal person course on beliefs about suicide, stigmatising attitudes, confidence to help, and intended and actual helping actions: an evaluation

BACKGROUND

Suicide is a significant concern in Australia and globally. There is a strong argument for training community gatekeepers in how to recognise and support suicidal people in their social network. One such training course is the Mental Health First Aid for the Suicidal Person course. This course was developed using suicide prevention best practice guidelines based on expert opinion (determined using the Delphi Method).

METHODS

We evaluated the impact of attending the Mental Health First Aid for the Suicidal Person course on suicide literacy and stigma, confidence in and quality of intended and actual helping behaviours towards a person who is suicidal, and course satisfaction. Surveys were administered before and immediately after the course, and at 6-month follow-up. Data were analysed to yield descriptive statistics (percentages, means, standard deviations), with linear mixed models and generalized linear mixed models being used to test the statistical significance of changes over occasions of measurement.

RESULTS

We recruited 284 participants from workplaces and general community networks. The mean age was 41 years and 74% were female. 85% of people undertook the course as part of professional development, and almost half (44%) did the course because they had contact with a suicidal person. The majority (59%) of participants had previous mental health and suicide prevention training. The majority of participants held knowledge (suicide literacy) before undertaking the course. The major effect of training was to strengthen this knowledge. There was a significant improvement from pre-course (M = 1.79, SD 0.56) to post-course (M = 1.48, SD 0.82, p < 0.0001), which was maintained at follow-up (M = 1.51, SD 0.49, p < 0.0001). Confidence in gatekeeper skills significantly improved after the course and at follow-up (M = 3.15, SD 0.95 before the course to M = 4.02, SD 0.68 afterward and 3.87, SD 0.77 at follow-up, p < 0.0001 and p < 0.0001, respectively). The quality of intended helping behaviours significantly improved from pre-course (intended actions M = 4.28, SD 0.58) and to post-course (M = 4.70, SD 0.50, p < 0.0001) and were maintained at follow-up (M = 4.64, SD 0.41, p < 0.0001). There was significant improvement in some of the actions taken by participants to help a suicidal person from pre-course to post-course (e.g. asking about suicidal thoughts and plan, contacting emergency services). The course was highly acceptable to participants.

CONCLUSION

These results indicate that this course is an acceptable intervention that delivers a broad spectrum of beneficial outcomes to community and workplace gatekeepers.

Belief in suicide prevention myths and its effect on helping: a nationally representative survey of Australian adults

BACKGROUND

Debunking suicide myths, such as 'asking someone about suicide could make them start thinking about it' is a common strategy in suicide prevention education. However, there has been little research investigating the relationship between suicide myths and helping behavior toward people at risk of suicide. We aimed to identify sociodemographic characteristics associated with belief in eight common suicide myths and the associations between beliefs in these myths and helping intentions and behaviors toward a family member or friend in severe distress or at risk of suicide.

METHODS

We conducted a random digit dial (mobile and landline) survey of 3002 Australian adults. We asked respondents about their beliefs in suicide myths, intentions to help a person in severe distress or at risk of suicide presented in a vignette, and helping actions taken toward such a person in the last 12 months. We weighted this data to be representative of the Australian population. Regression analyses were undertaken to determine associations between sociodemographic and exposure characteristics and beliefs in suicide myths, and between beliefs in myths and helping intentions and behaviors.

RESULTS

Being male, speaking a language other than English at home and being over 60 years were associated with the strongest beliefs in suicide myths. The strongest and most consistent associations were found between belief in the myth 'asking someone about suicide could make them start thinking about it', risk assessment intentions and behaviours and intentions to undertaken actions not recommended for suicide prevention.

CONCLUSIONS

Identifying those sociodemographic groups most likely to believe in suicide myths allows targeted intervention for suicide prevention education 'debunking' suicide myths. By isolating those myths that are most commonly believed, and their specific effects on helping intentions and behaviors, suicide prevention educators can target these specific myths to have the most effect on helping behavior. Our findings suggest that targeting the myth 'asking someone about suicide could make them start thinking about it' may have the greatest effects on helping behavior, and that men, those aged over 60 years and those speaking a language other than English at home could most benefit from myth 'debunking'.

Exposure to suicide in Australia: A representative random digit dial study

BACKGROUND

Exposure to the suicide death of another may lead to distress and increase the risk of suicide in those connected to the deceased. Yet, the extent of this exposure across the population is ill-defined. This paper utilises representative data to quantify the extent of exposure to suicide in the Australian community and the reported effect of this exposure.

METHODS

A random digit dial, computer-assisted telephone interview survey was undertaken to understand how Australian's may assist someone in severe distress or at risk of suicide. Embedded within this survey were questions on exposure to suicide and the impact of this exposure.

RESULTS

Among a representative sample of 3002 Australians, 58% reported exposure to the suicide of someone known to them in their lifetime and 18.5% of exposed individuals reported their own suicidal thoughts in the past-year. Higher perceived impact of the suicide and concern for another person were associated with increased likelihood of current suicidal thinking.

LIMITATIONS

Survey design limitations resulted in unknown psychological harms beyond past-year suicidal thinking in respondents.

CONCLUSIONS

Our findings demonstrate a high level of exposure to suicide death among Australians, with multiple exposures common. How and why suicide manifests in some exposed to suicide and not others remains unknown and requires further research. However, these findings suggest suicide prevention efforts need to expand to include a focus on suicide exposure, and mental health clinicians should consider exposure to suicide in risk assessment to better understand an individual's vulnerability to suicide following exposure.

Australian R U OK?Day campaign: improving helping beliefs, intentions and behaviours

Background

Suicide is a major public health concern and has been recognised as a public health priority. R U OK?Day aims to prevent suicide by encouraging and empowering Australians to reach out to friends and family who might be experiencing personal difficulties. This study aims to update the evaluation of the public awareness campaign ‘R U OK?Day’ that was conducted using 2014 data.

Methods

Data from 2013 participants were collected via an online survey following the R U OK?Day campaign implemented in 2017. Outcome measures included campaign awareness and participation, past 12-month help-seeking, helping beliefs, helping intentions and helping behaviours. Data were analysed using z-tests, Chi square and regression analyses in SPSS.

Results

Both campaign awareness and participation have increased since 2014, from 66% and 19% to 78% and 32%. Campaign exposure was associated with stronger beliefs in the importance and the ease of asking “Are you okay?”, and increased the likelihood of intentions to use recommended helping actions by two to three times compared to those not exposed to the campaign. Participants who were exposed to the R U OK?Day campaign were up to six times more likely to reach out to someone who might be experiencing personal difficulties compared to those not exposed to the campaign. Interestingly, those who had sought help from a mental health professional in the past 12 months were more likely to be aware of, and participate in, the campaign, suggesting people experiencing mental health issues recognise the value of seeking—and giving—social support.

Conclusions

The R U OK?Day campaign continues to be relevant and effective in spreading key messages about the importance of reaching out to others and empowering members of the community to have conversations about life problems. The campaign’s impact is increasing over time through increased campaign awareness and participation, and improving helping beliefs, intentions and behaviours. Ongoing monitoring and evaluation of the campaign’s impact is vital and may inform potential changes needed to further enhance its impact.

Helping actions given and received in response to suicide risk: Findings from an Australian nationally representative telephone survey

We conducted a nationally representative telephone survey of 3000 Australian adults. We assessed helping responses toward people in severe distress and experiencing suicidal thoughts by asking whether respondents had undertaken 15 specified helping actions (10 recommended and 5 non-recommended actions) to support such a person. We also asked respondents who had experienced suicidal ideation in the last 12 months whether the most helpful person at that time had undertaken the 15 specified helping actions. We weighted the data to represent the Australian adult population, calculated percentage frequencies for the helping actions and used logistic regression to analyse whether sociodemographic and exposure variables related to helping actions taken. Recommended supportive actions consistent with best practice were most commonly undertaken (e.g., listened to their problems without judgement: 96.5%, 95% CI 94.6–97.7); however, some non-recommended actions (e.g., reminded the person what they have they going for them: 91.6%, 95% CI 89.1–93.5) were also very common. Suicide risk assessment actions such as asking if they had a plan for suicide (39.8%; 95% CI 35.0–44.9), and encouraging professional help (e.g., helped make an appointment with a health professional: 61.3%, 95% CI 57.4–65.2) were relatively uncommon. Age, gender, level of education, language spoken at home, own suicidal ideation and suicide prevention training were shown to affect the odds of carrying out various helping actions. Australian adults need to be educated to ask direct questions about suicide risk and to encourage others in distress to seek professional help. There may also be a place for discouraging certain behaviours that oppose best practice in suicide prevention. While most previous studies have assessed intentions to help a person at risk of suicide, this study makes a unique contribution to the literature by assessing ‘real-world’ helping behaviour, including the occurrence of helping actions undertaken that oppose best practice in suicide prevention.

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Surveys a nationally representative sample of Australian adults (n = 3000).

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Identifies helping actions from non-professionals toward people at risk of suicide.

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Finds that actions opposing suicide prevention best practice are common.

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Finds that asking questions to assess suicide risk is uncommon.

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Actions taken predicted by sociodemographics, suicidal ideation and training.