Comprehensive psychometric examination of the attitudes towards suicide (ATTS) in South Korea

Effectiveness of Gatekeeper Training for Families of People With Mental Disorders in Korea: A Randomized Controlled Trial

OBJECTIVE

Given the high suicide risk among people with schizophrenia and other mental disorders and the significance of intervention in the daily life setting, tailored gatekeeper training is necessary for families of people with mental disorders. This study evaluated the effectiveness of a suicide prevention education program for families of people with mental disorders (SPEM-F), developed by the Korea Foundation for Suicide Prevention.

METHODS

Fifty-nine family members of people with mental disorders were recruited from eight community psychiatric rehabilitation centers in Korea and enrolled in a cluster randomized controlled trial. Four facilities were randomized to the experimental group (n=30) and four to the control group (n=29). The study parameters were measured at baseline, post-intervention, and 1-month follow-up; the effects of SPEM-F (90 minutes, conducted offline) were analyzed using repeated-measures analysis of variance. The dependent variables were suicide-related knowledge, attitude, self-efficacy, preventive behavioral intention, and family problem-solving communication.

RESULTS

The experimental group showed significant increases in suicide-related knowledge (p<0.001), self-efficacy (p<0.05), and preventive behavioral intention (p<0.01) compared with the control group until the 1-month follow-up, including an upward trend in improved family problem-solving communication (p=0.069).

CONCLUSION

The results confirm that SPEM-F is an effective evidence-based gatekeeper training program for families of people with mental disorders, as it focuses on knowledge, self-efficacy, preventive behavioral intention, and communication improvement. As families of people with mental disorders including schizophrenia, are both highly motivated and close to people at high risk for suicide, SPEM-F can effectively promote suicide prevention and gatekeeper activities.

Effect of Attitude Toward Suicide on Suicidal Behavior: Based on the Korea National Suicide Survey

OBJECTIVE

Suicide is a complex phenomenon; therefore, it should be approached in light of sociocultural perspectives and the general attitude toward suicide. This study aimed to extract factors from the Attitude Toward Suicide Scale (ATTS) and investigate the relationship between attitudes toward suicide and suicidal behavior (i.e., suicidal idea, plan, and attempt) by using a representative sample of Korean adults.

METHODS

Three thousand Koreans aged 19 to 75 years were surveyed cross-sectionally in 2013 and 2018. The data collected were subjected to exploratory factor analysis. Extracted attitude factors were compared using a suicidal behavior continuum. Univariate and multivariate logistic models were constructed to compare the association between attitude factors and suicidal behaviors.

RESULTS

Among the participants, 477 (15.9%) experienced suicidal idea only, 85 (2.8%) had a suicidal plan without attempt, and 58 (1.9%) attempted suicide. Four meaningful factors were extracted from the factor analysis: "permissiveness," "unjustified behavior," "preventability/readiness to help," and "loneliness." "Permissiveness," "unjustified behavior," and "loneliness" factors showed significant trends across the suicidal behavior continuum. Permissive attitude toward suicide increased the odds of suicidal idea, suicidal plan, and suicide attempt (adjusted odds ratio [aOR]=1.49, 95% confidence interval [CI]=1.25-1.79; aOR=2.79, 95% CI=1.84-4.25; aOR=2.67, 95% CI=1.65-4.33), while attitude toward suicide as unjustified behavior decreased the odds of suicidal ideation and attempt (aOR=0.79, 95% CI=0.67-0.94; aOR=0.64, 95% CI=0.42-0.99).

CONCLUSION

A significant association was found between attitude toward suicide and suicidal behaviors. Attitude toward suicide is a modifiable factor that can be used to develop prevention policies.

Attitude Towards Suicide among Caregivers of Patients Admitted with Suicide Attempt to a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction:

Understanding the attitude of caregivers towards suicide attempters could be useful in suicide prevention. The objective of this study was to study attitude towards suicide among caregivers of patients with suicide attempt admitted to a tertiary care hospital in Nepal.

Methods:

A descriptive cross-sectional study was conducted with 52 caregivers of patients with suicide attempt who had been admitted to a tertiary care hospital of Nepal after obtaining ethical clearance from Institutional Review Committee (ref. IRC/0797/016). Data were collected through interviews using the Attitude towards Suicide Questionnaire and in-depth interviews conducted on five caregivers using the interview framework developed in the department for the purpose. Data and descriptive analysis were done using Statistical Package for the Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Content analysis was used for qualitative data.

Results:

Majority of the caregivers 34 (65.4%) had unfavorable attitude towards suicide. Caregivers reported that mental and chronic physical illness, financial difficulty, working environment, and social factors such as undue pressure and failure to perform the task, difficulty maintaining the relationship, abuse, and neglect could be some of the possible causes of suicide. Caring and understanding attitude of family members, health professionals, and society towards the suicidal individuals providing appropriate training and education to the public would help in reducing the stigma and burden of suicidal patients.

Conclusions:

The overall attitude of the caregivers was unfavorable. Interventions targeted towards improving attitude towards suicide could be helpful in suicide prevention.

Measuring Attitudes toward Suicide Prevention among Occupational Staff Frequently Exposed to Suicidal Individuals: Psychometric Evaluation and Validation

As the attitudes of healthcare staff are thought to influence the quality and effectiveness of interventions targeting patients’ suicide risk, attitudes are often used as an outcome in the evaluation of suicide-preventive training. Due to various problems related to the validity and reliability of commonly used scales, there is a lack of overall agreement on how to measure these attitudes. Confirmatory factor analysis (CFA) was used to cross-validate previously used models and to investigate new models to measure professionals’ attitudes toward work with suicidal individuals and to test the longitudinal stability of the models by analyzing new sets of data. The population in the first study consisted of a heterogenous group of 1350 professionals who managed suicidal individuals relatively frequently. The second study included 640 professionals. The results of the cross-validation of previous models were described and a new questionnaire measuring attitudes toward suicide prevention, suicidal individuals, and organizational-facilitated self-efficacy (OSAQ-12) was presented. The three presented models retained a good fit and were stable over time. Valid and reliable measurement models that measure aspects of attitudes toward suicide are a prerequisite for conducting both cross-sectional and intervention studies.

Student Pharmacists' Attitudes Toward Suicide and the Perceived Role of Community Pharmacists in Suicidal Ideation Assessment

Objective. To determine first-year Doctor of Pharmacy students' attitudes toward suicide and perceptions of the role of the pharmacist in assessing patients for suicidal ideation, and whether their previous pharmacy work experience influences these attitudes and perceptions. Methods. An anonymous online survey was administered to first-year student pharmacists at one school of pharmacy in North Carolina. Measures included gender, previous community pharmacy work experience, personal contact with suicide, and score on the Attitudes Toward Suicide (ATTS) scale. Results. Seventy-three student pharmacists (75%) completed the survey. The vast majority (92%) agreed or strongly agreed that suicide was a real disease. Similarly, most students (79%) agreed or strongly agreed that pharmacists have a professional responsibility to assess for suicidal ideation. There was not a significant association between ATTS score and previous community pharmacy work experience nor the perceived pharmacist's role in assessing for suicidal ideation. Additionally, there was no association between ATTS score and personal contact with suicide. Conclusion. First-year student pharmacists, while undecided on their personal attitudes toward suicide, overwhelmingly agreed that suicide is a disease and that pharmacists have an important role in assessing patients for suicidal ideation. Pharmacy schools should implement training programs to prepare student pharmacists to identify suicidal ideation, design interventions to address student pharmacists' personal beliefs that may impact their ability to provide patient care, and provide students with adequate support skills to care for patients experiencing mental health crises.

Suicidal ideation, suicidal behaviors, and attitudes towards suicide of adolescents enrolled in the Alternative Learning System in Manila, Philippines-a mixed methods study

BACKGROUND

Globally, suicide is a significant cause of death among adolescents. Previous studies conducted in high-income countries suggest that students in alternative schools are more likely to engage in suicidal behaviors than those in formal schools. This study aimed to document suicidal ideation and behaviors among adolescent learners enrolled in the Alternative Learning System (ALS) in Manila, Philippines.

METHODS

A mixed methods study was conducted in 24 ALS centers in the city of Manila. ALS centers were stratified according to congressional district and selected using probability proportionate sampling. A cross-sectional survey to determine attitudes towards suicide and prevalence of suicidal ideation and behaviors was administered to 171 learners aged 13 to 17 years old. In-depth interviews with 18 teachers and 12 learners were conducted to explore the school psychosocial environment's role on learners' suicidal ideation and behaviors. Exploratory factor analysis was used to extract attitude factors. Fisher's exact test and Student's t-test were used to identify differences in sociodemographic characteristics and attitudes towards suicide between learners with or without suicidal ideation or behaviors. Qualitative data were analyzed using thematic analysis.

RESULTS

Non-specific active thoughts were the most common type of lifetime suicidal ideation (40.9%) while passive ideation was the most common in the past month (13.5%). Aborted suicide attempt was the most frequent behavior in both lifetime (16.4%) and in the past month (4.7%). Non-fatal suicide attempt in the past month was 2.3%, reaching 12.9% for the entire lifetime. Age, sex, education, and attitudes towards suicide were significantly associated with suicidal ideation or behavior. Thematic analysis showed five themes: (1) fostering belongingness, (2) securing learners' safety, (3) teaching philosophy, (4) teacher and learner beliefs towards suicidal behavior, and (5) availability of school-offered and community-based services.

CONCLUSION

Suicidal ideation and behaviors are prevalent among adolescent ALS learners. This study also showed a significant difference in attitudes towards suicide and sociodemographic characteristics between learners with and without suicidal ideation behaviors. It also suggests that the school psychosocial environment, through social norms and learner-teacher interactions, can potentially prevent progression of suicidal ideation to behavior, influence help-seeking, and promote mental health among learners.

Psychometric evaluation of the Questionnaire on Attitudes Towards Suicide (ATTS) in Poland

The Questionnaire on Attitudes Towards Suicide (ATTS) is widely used to evaluate the views of an individual regarding acceptability of suicide and orientation towards suicide prevention. However, recent findings suggest that it requires some revision. The present study examines the factor structure of the ATTS questionnaire in two Polish samples, consisting of 239 students (sample one) and 128 students (sample two) of the helping professions. The previously-established 10-factor model was not supported by confirmatory factor analysis (CFA). Theoretical revaluation of the scale followed by factor analysis suggested that the best fit was provided by a five-factor model accounting for 48.2% of the variance. The adapted Polish ATTS questionnaire showed satisfactory reliability and validity; however, the factor loading patterns and factor structure varied from earlier studies. These improvements in the ATTS theoretical base and construct validity may enhance the utility of the revised scale.

A Comparison of Attitudes Toward Suicide Among Individuals With and Without Suicidal Thoughts and Suicide Attempts in South Korea

Abstract. Background: A suicidal person can go through different stages that include suicidal thoughts and suicide attempts. For a few individuals, these can end up with suicide. However, there have been no studies investigating any differences in attitudes toward suicides among individuals with no suicidal thoughts, those with suicidal thoughts, and those with suicide attempts. Aims: This study was carried out to compare attitudes toward suicide among three different groups: individuals with a history of no suicidal thoughts, those with a history of suicidal thoughts, and those with a history of suicide attempts. Method: To examine Koreans' attitudes toward suicide, we analyzed the data from the 2013 National Suicide Survey involving 1,500 participants aged between 19 and 75 years. Results: Different attitudes toward suicide were found among the three groups. Persons reporting that they had made a suicide attempt in their life showed the most permissive attitudes toward suicide. Limitations: Since this research is based on cross-sectional data, it is difficult to eliminate the possibility of changes in attitude toward suicide completely after having a suicidal thought and suicide attempt. Conclusion: These results can be a useful source for constructing effective messages for suicide prevention campaigns and can ultimately contribute to an improvement in the public's perceptions of suicide in the future.

Examination of the latent factor structure and construct validity of the stigma of suicide scale-short form

A major limitation of research on attitudes toward suicide is that most measures lack evidence of a stable factor structure. To investigate the structure of recently developed stigma of suicide scale-short form (SOSS-SF), we conducted an exploratory factor analysis in a sample of 499 undergraduates. Results revealed a three-factor structure: Stigma, Isolation/Depression, and Glorification/Normalization. We also identified good convergent and discriminant validity between the SOSS-SF and related constructs. In a separate sample of 570 undergraduates, a confirmatory factor analysis (CFA) demonstrated adequate fit for the three-factor model. In addition, a multiple-group CFA demonstrated invariance across gender.

Cross-Cultural Adaptation and Validation of the Attitudes Toward Suicide Questionnaire Among Healthcare personnel in Malaysia

Understanding attitudes toward suicide, especially among healthcare personnel, is an important step in both suicide prevention and treatment. We document the adaptation process and establish the validity and reliability of the Attitudes Toward Suicide (ATTS) questionnaire among 262 healthcare personnel in 2 major public hospitals in the Klang Valley, Malaysia. The findings indicate that healthcare personnel in Malaysia have unique constructs on suicide attitude, compared with the original study on a Western European sample. The adapted Malay ATTS questionnaire demonstrates adequate reliability and validity for use among healthcare personnel in Malaysia.