The ripple effect: a digital intervention to reduce suicide stigma among farming men

Local Men Local Communities: A rural placed-based approach to increase men's engagement with mental health training and events

ISSUE ADDRESSED

Suicide is the leading cause of death for Australians aged 15-49 (Department of Health and Aged Care Suicide in Australia, https://www.health.gov.au/health-topics/mental-health-and-suicide-prevention/suicide-in-australia, 2021). With the loss of one community member impacting the individual's family, friends, and wider community. The aim of the article is to showcase a process evaluation of a place-based approach to suicide prevention, exploring the elements of mental health training and events that can be tailored to increase engagement with the men living in a rural Local Government Area in Gippsland, Victoria, Australia.

METHODS

Participation records and promotional material for the Local Men Local Communities project was utilised to explore similarities and differences between the training and events offered.

RESULTS

Results indicated that men living in rural areas engaged best with events that included a social element such as food or an activity, highlighting that men may find it easier to talk and connect when they have something to do.

CONCLUSION

Mental health training and events need to be tailored to meet the needs of the target population. Key details to consider include location, time, promotional material, content, and inclusion of a social element. SO WHAT?: When rural men were provided ownership of their conversations, they were more likely to have them. This challenges the stereotype that men do not talk and creates the opportunity for social connection within the community.

Workplace Interventions Targeting Mental Health Literacy, Stigma, Help-Seeking, and Help-Offering in Male-Dominated Industries: A Systematic Review

Mental ill-health and suicide represent a significant proportion of the burden of global disease among men. Connell's relational theory of masculinities provides a useful framework to explore how mental health literacy, mental health stigma, and delayed help-seeking and help-offering behaviors are associated with mental ill-health among men, particularly within male-dominated industries. To address the high incidences of mental ill-health in male-dominated industries, several workplace interventions targeting these outcomes have been implemented. No review to date has examined the current state of evidence for these interventions or identified the behavior change techniques used. This review was restricted to empirical, quantitative research reporting on psychosocial interventions targeting mental health literacy, stigma, and help-seeking and help-offering behaviors in male-dominated industries. Quality appraisal was completed using the Effective Public Health Practice Project and a narrative synthesis was conducted. Twelve articles were included for review which reported on four distinct interventions. The methodological quality of two articles was strong, three moderate and seven weak. The strongest evidence of intervention effects related to mental health literacy and help-seeking intentions. There was less evidence relating to help-offering and help-seeking behaviors and mental health stigma. Sixteen behavior change techniques were identified across interventions that are discussed in relation to the wider men's health literature. The evidence on psychosocial interventions in male-dominated industries is limited due to methodological and conceptual issues. Recommendations for future research include standardized reporting of intervention descriptions, the use of theory to guide intervention development, and utilizing validated and reliable outcome measures.

Evaluation of an online suicide prevention program to improve suicide literacy and to reduce suicide stigma: A mixed methods study

Low-threshold e-health approaches in prevention to reduce suicide stigma are scarce. We developed an online program containing video reports on lived experience of suicide and evidence-based information on suicidality. We evaluated the program by a mixed methods design. We examined pre-post-changes of program completers (n = 268) in suicide literacy, suicide stigma (self and perceived), and self-efficacy expectation of being able to seek support in psychologically difficult situations using linear mixed models. To examine reported changes and helpful program elements 12-26 weeks after program completion, we content analyzed transcripts of telephone interviews (n = 16). Program completers showed more suicide literacy (Cohen's d = .74; p < .001), higher self-efficacy expectations to seek support (d = .09; p < .01), lower self-stigma (subscales glorification/normalization: d = -.13, p = .04; isolation/depression: d = -.14; p = .04; stigma: d = -.10; p = .07; n = 168) compared to baseline. We found no significant differences in perceived suicide stigma. We identified lived experience reports, the possibility of sharing own narrative on stigma and suicidality, and information on support as helpful elements. The current online program can increase suicide literacy and self-efficacy expectations to seek support and reduce self-stigma. We recommend a larger randomized controlled trial with longer follow-up to confirm these findings.

Farmers Supporting Farmers: Livestock Auctions as Spaces to Reconstruct Occupational Community and Counter Mental Health Issues

Social isolation within agricultural communities is prevalent within the United Kingdom (UK). Along with other social and economic determinants, social isolation is considered to be a contributing factor towards the high rates of mental health issues experienced among people working in agriculture. The livestock auction mart is one of the remaining spaces upon which many livestock farmers rely for consistent social interaction and to experience community, both determinants proven to improve physical and mental health. However, the importance of the social contribution of livestock auction marts to farmer wellbeing appears rarely in associated literature. The aims of this study, therefore, were i) to determine levels of isolation experienced by livestock farmers who attend auction marts and ii) to identify the role of the mart as a system of social support, with an emphasis on the informal support system attendees provide for one another. Findings from 90 qualitative interviews demonstrate that the auction mart is an important social site where occupational community and identity can be produced and reproduced for all attending stakeholders, positively impacting upon mental health and wellbeing. The strength of the occupational community among livestock farmers should be considered as a key element among a basket of options approach in the development of support interventions, and as a pathway to negotiating barriers to both help-seeking behaviors and reaching the hard-to-reach.

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.

Suicidal ideation in men during COVID-19: an examination of protective factors

BACKGROUND

Men account for three-quarters of all suicide deaths in many Western nations including Australia. Whilst extensive research has examined risk factors for suicidal ideation and behaviour in men, protective factors remain underexplored, particularly social support, resilience and coping behaviours. Such factors are important to examine particularly in the context of COVID-19, where enforced isolation (among other negative lifestyle effects) has created widespread risk for the development of suicidal ideation. This mixed-methods study aimed to examine associations of various protective factors with suicidal ideation in men, using data from an online survey conducted during the COVID-19 pandemic. In addition, we aimed to qualitatively investigate men's self-reported protective strategies when experiencing suicidal thoughts and behaviour.

METHODS

A convenience sample of 700 men (age M = 50.3 years; SD = 15.2 years) responded to an online survey including quantitative measures of suicidal ideation, planning and attempt, alongside employment and relationship status, coping, social support, resilience, and a qualitative free-text item gauging men's self-reported protective strategies. Multinomial logistic regression was applied to compare odds of sub-categories of suicide risk (ideation; planning) according to protective factors. Qualitative responses were analysed via thematic analysis.

RESULTS

Men in a relationship, and those lower in emotion-focused and avoidant coping reported lower odds of suicidal ideation. Maintaining employment throughout the pandemic was protective against suicidal ideation and planning; as was greater perceived social support from friends. Greater self-reported resilience was protective against suicidal ideation and planning. Qualitative analyses led to the development of two themes: coping and connecting, reflecting men's intra- and interpersonal management strategies; and sustaining selflessness, where men's imaginings of the collateral damage of their suicidal behaviour was protective against action on suicidal thoughts or plans.

CONCLUSIONS

Findings of this study speak to the nuanced roles of interpersonal connections, resilience and coping behaviours in protecting against suicidal ideation and planning in men. In addition, qualitative insights further cement men's identification with familial protector and/or provider roles as protective against suicidal action.

The Role of Social Work in Confronting the Farmer Suicide Crisis: Best Practice Recommendations and a Call to Action

Although estimates of prevalence vary, suicide rates among farmers are high and pose an important challenge for mental health policy and practice. The lack of mental health resources in many rural communities is a significant barrier to improving farmer mental health outcomes. The current paper will review (1) current findings related to the psychosocial functioning of agriculturalists including rates of suicide and common mental health concerns within this population; (2) describe stressors and risk factors associated with mental health symptoms in rural and agricultural communities; and (3) discuss barriers associated with accessing mental health treatment. This article also includes recommendations for increasing the cultural competence of social work practitioners working with rural communities. Finally, existing research on using technology and workforce development approaches for increasing access to mental health in rural communities is presented and recommendations for future research are explored.

Linking music streaming platform advertisements with a digital mental health assessment and interventions

Accessibility issues and low rates of help-seeking hinder engagement with mental health resources and treatment. Pragmatic, (cost-)effective solutions are required to increase engagement with efficacious digital mental health interventions (DMHIs) including for hard-to-reach individuals. As an example, music-based interventions have been positively used in health care to reduce stress, anxiety and depression through music medicine, music therapy and recreational use. Although, enhanced mental health awareness from music listening has yet to be converted into engagement with a DMH assessment (DMHA) and DMHIs. Therefore, a new study is proposed to place linked advertisements on Spotify, the most used music streaming platform. MindSpot's vetted DMHA is suitable to use as an example for linking unto because it measures depression, anxiety, general mental well-being problems and psychological distress in Australian adults and provides access to DMHIs. The primary aim is to provide a convenient, robust and scalable consumer pathway to reduce engagement barriers and maximize facilitation to a vetted DMHA and DMHIs. The proposed study is important because it addresses notorious help-seeking difficulties in the adult population (e.g., young people and men). It also expands outreach to the underserved and the unserved and streamlines the integration of digital solutions with mental health services.

Experiences With Suicide Loss: A Qualitative Study

To better understand suicide loss survivors' experiences and barriers to accessing support and mental health care, 28 (21 women and 7 men) suicide loss survivors were interviewed. Using qualitative analysis of 28 in-depth, semi-structured phone interviews data, three categories emerged: Life before Suicide, Life after Suicide, and Meaning of Life. This deeper understanding of suicide loss survivors along with inclusion of experiences of male and rural participants' suicide loss, fill previously identified research gaps. Our findings suggest importance in providing emotional support and mental health resources to those with suicide intent or experiences with suicide loss. Most importantly, the recognition of suicide loss survivors extends beyond the immediate family and includes cousins, friends, and work associates. Recognition of extended suicide loss survivors' bereavement will provide additional opportunities for healthcare providers to effectively intervene with this vulnerable population.

Mental Health and Substance Use of Farmers in Canada during COVID-19

Farmers in Canada faced higher levels of mental distress than the general public prior to the Coronavirus Disease 2019 (COVID-19) pandemic and are generally less likely than the public to seek help. However, the mental health impacts of COVID-19 on farmers in Canada remain unexplored. Our objective was to investigate mental health outcomes among farmers in Canada by gender and within the context of COVID-19. We conducted a national, online, cross-sectional survey of farmers in Canada (February-May 2021). The survey included validated scales of anxiety, depression, perceived stress, burnout (emotional exhaustion, cynicism, professional efficacy), alcohol use, resilience, and questions regarding participants' perceived changes in these outcomes during the pandemic. Data were also collected on the impact of COVID-19 specific social and economic factors on mental health, help-seeking, and sense of community belonging through the pandemic. Descriptive statistics were summarized, and Chi-square analyses and t-tests were conducted to compare survey results between genders and to data collected in our similar 2016 survey and normative population data. A total of 1167 farmers participated in the survey. Participants scored more severely across scales than scale norms and the general Canadian population during COVID-19. Scale means were consistent between the 2016 and 2021 samples. Most participants with moderate to severe scores for any outcome reported worsening symptoms since the pandemic began. Women fared significantly worse than men across measures. Over twice as many women reported seeking mental health or substance use support during the pandemic than men. Participants rated the mental health impacts of all social and economic factors related to COVID-19 examined significantly (p < 0.05) differently than the Canadian public. The pandemic has negatively impacted the mental health of farmers in Canada and in ways that differ from the general population. National level and gender-specific mental health supports are needed to help improve the mental health of farmers in Canada.

Participant perspectives of an online co-design process to develop a prevention-focused mental health and well-being platform for primary producers

OBJECTIVE

To explore participant experiences of an online co-design process to develop a web-based preventative mental health and well-being intervention targeting primary producers in rural Australia.

SETTING

Rural Victoria, Australia.

PARTICIPANTS

Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co-design and beta testing processes for a primary producer platform.

DESIGN

A qualitative study using semi-structured phone-based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes.

RESULTS

Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co-design participation, (3) experiences of the co-design process, (4) maintaining a shared vision and goals and (5) acting on the co-design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co-design using face-to-face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face-to-face.

CONCLUSIONS

Using an online co-design method to develop a preventative mental health and well-being web-based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co-design process and identify opportunities to improve participant engagement and experience with the online format.

A Scoping Review of Community-Based Adult Suicide Prevention Initiatives in Rural and Regional Australia

The need for continued research into suicide prevention strategies is undeniable, with high global statistics demonstrating the urgency of this public health issue. In Australia, approximately 3000 people end their lives each year, with those living in rural and regional areas identified as having a higher risk of dying by suicide. Due to decreased access and support services in these areas, community-based suicide prevention initiatives provide opportunities to educate and support local communities. A scoping review was conducted to explore the literature pertaining to such programs in rural and/or regional communities in Australia. This review follows the five-stage Arksey and O’Malley (2005) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Nine databases were searched, from which studies were considered eligible if suicide prevention programs were community-based and catered for adults (aged ≥ 18 years) in rural or regional Australia. Ten papers that met our inclusion criteria were included in this review, showcasing a variety of interventions such as workshops, a digital intervention, art therapy, and initiatives to increase education and reduce stigma around suicide. Program engagement strategies included the importance of providing culturally appropriate services, the inclusion of lived experience mentoring, and tailoring the suicide prevention program to reach its targeted audience. Overall, there is a dearth of literature surrounding community-based suicide prevention initiatives for adults in rural and regional Australia. Further evaluation of community-based projects is required to ensure quality improvement and tailored suicide prevention initiatives for rural and regional Australians.

Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review

BACKGROUND

A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs.

OBJECTIVE

This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach.

RESULTS

Overall, 52 eligible programs were identified, of which 9 (17%) addressed depression, 15 (29%) addressed anxiety, 13 (25%) addressed general mental well-being, and 13 (25%) addressed multiple issues. Only 4% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44% to 100%, with a total average score of 85%.

CONCLUSIONS

There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist.

The Potential Impact of Adjunct Digital Tools and Technology to Help Distressed and Suicidal Men: An Integrative Review

Suicidal men feel the need to be self-reliant and that they cannot find another way out of relationship or socioeconomic issues. Suicide prevention is of crucial importance worldwide. The much higher rate of suicide in men engenders action. The prelude is a subjective experience that can be very isolating and severely distressing. Men may not realize a change in their thinking and behaviors, which makes it more difficult to seek and get help, thereby interrupting a "downward spiral". Stoicism often prevents men from admitting to their personal struggle. The lack of "quality" connections and "non-tailored" therapies has led to a high number of men "walking out" on traditional clinical approaches. But there are complicated relationships in motivations and formative behaviors of suicide with regards to emotional state, psychiatric disorders, interpersonal life events and suicidal behavior method selection. Middle-aged and older men have alternated as the most at-risk of suicide. There is no one solution that applies to all men, but digital tools may be of assistance (e.g., video conferences, social networks, telephone calls, and emails). Digital interventions require higher levels of effectiveness for distress and suicidality but self-guided approaches may be the most suitable for men especially where linked with an integrated online suicide prevention platform (e.g., quick response with online chats, phone calls, and emails). Furthermore, technology-enabled models of care offer promise to advance appropriate linking to mental health services through better and faster understanding of the specific needs of individuals (e.g., socio-cultural) and the type and level of suicidality experienced. Long-term evidence for suicidality and its evaluation may benefit from progressing human computer-interaction and providing impetus for an eminent integrated digital platform.

Farmer Mental Health Interventions: A Systematic Review

The prevalence of mental health disorders and suicide amongst agricultural producers is a global problem. Community leaders, researchers, policymakers, and clinicians have mobilized to develop programs to address this issue. This study reviewed a wide range of mental health interventions targeting farmer mental health spanning over 50 years and examined their reported effectiveness and constraints. A total of ninety-two articles on farmer mental health were included in a final systematic review. Most articles were written concerning mental health literacy and peer and paraprofessional support interventions in the United States and Australia. Among the 56 studies reporting empirical evaluative data, 21 were mixed-method, 20 quantitative, 11 qualitative, and 5 literature synthesis. Non-experimental, self-reported, and qualitative data suggest efficacy of mental health literacy programs, peer and paraprofessional support, and community-based and agroecological interventions. However, most interventions were not subject to rigorous evaluation and only one intervention was evaluated using a control condition. The heterogeneity of existing studies and paucity of rigorous evaluation proscribes firm conclusions related to program-type efficacy. This review demonstrates that there is still a need for a stronger and broader evidence base in the field of farmer mental health interventions, which should focus on both holistic, multi-component programs and targeted approaches.

[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.

An integrated review of the barriers and facilitators for accessing and engaging with mental health in a rural setting

The review investigated the barriers and facilitators associated with assessing and engaging with mental health in a rural setting. The aim is to describe and synthesize the literature that examines the experiences of adults who access or attempt to access mental health services in rural settings. A systematic search from 2010 to 2020 was conducted using CINAHL, PsycINFO, Web of Science Core Collection, PubMed, Psychology and Behavioural Sciences Collection, Google Scholar, and Scopus. PRISMA protocols located 32 relevant papers from the overall 573 first selected. Braun and Clarke (Qualitative Research in Psychology, 3:77-101, 2006) thematic analysis methodology was applied to the data resulting in two themes: first theme identified help-seeking with subthemes of stigma and locality of health services. The second theme was connectedness, inclusive of subthemes of support systems and personal identity. The review identified gender-related perspectives concerning accessing mental health support, exposing the need for more research to examine the diverse social connections and support networks in rural communities. The findings suggest the need to further explore the impediments that reduce the likelihood of accessing mental health services in rural communities.

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.

The Literacy of Suicide Scale

Background: Until recently, little was known about the public's knowledge of suicide or its association with help-seeking. Aims: In this article we describe the development, validation, and application of the Literacy of Suicide Scale (LOSS). Method: A total of 658 people participated in the development of the LOSS, while 191 participated in a validation study. Item response theory was used to identify LOSS items. A systematic review of the literature was conducted to ascertain the breadth of use and application of the LOSS. Results: Overall, 26 items were selected for the final version of the LOSS, with 12 items identified for a short form of the scale. The LOSS has been included in 25 studies across nine countries with general community, student, and clinical populations. The LOSS has demonstrated change in response to psychoeducation interventions and is associated with suicide stigma and help-seeking in select studies. Limitations: Further validation of the LOSS in clinical populations is needed. Conclusion: The LOSS is a comprehensive measure of suicide literacy that may be used to identify knowledge gaps, inform awareness-raising activities, and assess the effectiveness of interventions to improve suicide literacy. The LOSS has been used in a broad range of settings, demonstrating application to diverse populations and cultural contexts.

Acceptability, Safety, and Resonance of the Pilot Digital Suicide Prevention Campaign "Better Off With You": Qualitative Study

Background

The Interpersonal Theory of Suicide posits that there are three key elements of suicidal behavior: perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. The digital campaign Better Off With You was developed to directly challenge the idea of perceived burdensomeness among people who are contemplating suicide in 2 communities within Australia.

Objective

The aim of this study is to explore the needs and preferences of people with lived experience of suicidal thoughts and actions to inform the development of Better Off With You.

Methods

This study involved a series of focus groups that aimed to discuss campaign messaging, scope, and approach. People with lived experience of suicidal thoughts and actions attended the focus groups. After the completion of initial focus groups, the results informed the creation of campaign collateral by creative agencies. Early versions of the campaign collateral were then presented in the user testing sessions. Transcriptions were analyzed via thematic analysis.

Results

In total, 13 participants attended the focus groups and 14 attended the user testing sessions. The following three overarching themes were presented: acceptability, safety, and resonance. Participants believed that suicide is a serious and ongoing issue in their communities and welcomed a localized suicide prevention focus via peer-to-peer storytelling. The idea of perceived burdensomeness required clarification but was perceived as acceptable and relevant. Participants seemed drawn toward peer narratives that they perceived to be authentic, genuine, and believable as given by real people with lived experience. Campaign messaging needs to be clear and empathetic while directly talking about suicide. Participants did not anticipate any significant negative or harmful impact from any campaign videos and highlighted the importance of providing appropriate help-seeking information.

Conclusions

This iterative study provided important insights and knowledge about peer-to-peer storytelling in suicide prevention campaigns. Future campaigns should involve simple messaging, be validating and empathetic, and consider including a lived experience perspective.