Media Exposure of Suicidal Behaviour: An Umbrella Review

AIM

To analyse recommended interventions for the safe and responsible dissemination of suicidal behaviour in the media for preventive purposes.

BACKGROUND

Suicide is a serious public health problem that leads to more than 700,000 deaths per year, which translates into one death every forty seconds. The media play a significant role in shaping public perceptions and reflecting societal issues. Because of its active role in the construction of reality, the way in which the media report and expose suicidal behaviour has the capacity to influence the population in either a preventive or harmful way.

DESIGN

An umbrella review was carried out and a report was written according to the Preferred Reporting Items for Overviews of Reviews.

METHODS

We systematically searched for reviews published from inception to February 2023 in MEDLINE (PubMed), CINAHL and PsycInfo (via EBSCOhost), Web of Science, Embase, Cochrane Library of Systematic Reviews, Scopus, and Google Scholar. A narrative synthesis of the results was conducted.

RESULTS

Six systematic reviews with a moderate to high quality level were selected. Among the recommended interventions were the inclusion of positive messages of hope, resilience, or of overcoming the event, narratives with information on available resources or the promotion of support-seeking attitudes as an effective prevention mechanism, as well as the avoidance of repetitive reporting of the same suicide. The appropriate and responsible dissemination of information on suicidal behaviour in the media with complete and up-to-date information on available centres, organisations, institutions, and resources has proven to be effective, especially in vulnerable populations.

CONCLUSION

Educating and training the media in an appropriate approach to disseminating suicidal behaviour helps to reduce the number of suicidal behaviours. Knowing what information is advisable to include in the news item as well as what information to avoid is a strong point. Guidelines to promote responsible media reporting are a key component of suicide prevention strategies. This study was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 23 April 2022 with the registration number CRD42022320393.

Parent and Carer Skills Groups in Dialectical Behaviour Therapy for High-Risk Adolescents with Severe Emotion Dysregulation: A Mixed-Methods Evaluation of Participants' Outcomes and Experiences

BACKGROUND

There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom.

METHOD

This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants.

RESULTS

Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions.

DISCUSSION

Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT.

Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: the significance of suicide-related rumination, family functioning, and ongoing population-level stressors

BACKGROUND

Young people are most vulnerable to suicidal behaviours but least likely to seek help. A more elaborate study of the intrinsic and extrinsic correlates of suicidal ideation and behaviours particularly amid ongoing population-level stressors and the identification of less stigmatising markers in representative youth populations is essential.

METHODS

Participants (n = 2540, aged 15-25) were consecutively recruited from an ongoing large-scale household-based epidemiological youth mental health study in Hong Kong between September 2019 and 2021. Lifetime and 12-month prevalence of suicidal ideation, plan, and attempt were assessed, alongside suicide-related rumination, hopelessness and neuroticism, personal and population-level stressors, family functioning, cognitive ability, lifetime non-suicidal self-harm, 12-month major depressive disorder (MDD), and alcohol use.

RESULTS

The 12-month prevalence of suicidal ideation, ideation-only (no plan or attempt), plan, and attempt was 20.0, 15.4, 4.6, and 1.3%, respectively. Importantly, multivariable logistic regression findings revealed that suicide-related rumination was the only factor associated with all four suicidal outcomes (all p < 0.01). Among those with suicidal ideation (two-stage approach), intrinsic factors, including suicide-related rumination, poorer cognitive ability, and 12-month MDE, were specifically associated with suicide plan, while extrinsic factors, including coronavirus disease 2019 (COVID-19) stressors, poorer family functioning, and personal life stressors, as well as non-suicidal self-harm, were specifically associated with suicide attempt.

CONCLUSIONS

Suicide-related rumination, population-level COVID-19 stressors, and poorer family functioning may be important less-stigmatising markers for youth suicidal risks. The respective roles played by not only intrinsic but also extrinsic factors in suicide plan and attempt using a two-stage approach should be considered in future preventative intervention work.

Disclosure of Mental Health Problems or Suicidality at Work: A Systematic Review

Many adults experience mental health problems or suicidality. Mental health and suicidality are associated with stigma and discrimination. Little is known about disclosure of mental health or suicidality problems in workplaces and the role of stigma and discrimination in affecting disclosure. To address this gap, we conducted a systematic review following the PRISMA guidelines. Searches for peer-reviewed articles in MedLINE, CINAHL, Embase and PsycINFO identified 26 studies, including sixteen qualitative, seven quantitative and three mixed-methods studies. No studies were excluded based on quality assessment. All studies reported on mental health disclosure; none reported on disclosure of suicidal thoughts or behaviours. The narrative synthesis identified four overarching themes relating to disclosure of mental health problems in workplaces. Themes included beliefs about stigma and discrimination, workplace factors (including supports and accommodation), identity factors (including professional and personal identity, gender and intersectionality) and factors relating to the disclosure process (including timing and recipients), with all influencing disclosure decision making. Significantly, this review found that there is a gap in the existing literature relating to suicidality disclosure in workplaces, with none of the included studies investigating disclosure of suicidal thoughts and behaviours.

Burnout and Suicidal Behaviours in Health Professionals in Portugal: The Moderating Effect of Self-Esteem

The main objective of this study was to investigate the effect of burnout on suicidal behaviours and the mediating effect of self-esteem in this relationship. A total of 1172 healthcare professionals working in Portugal's private and public sector organisations participated in this study. The results indicate a high level of burnout among these professionals and that exhaustion (β = 0.16; p < 0.001) and disengagement (β = 0.24; p < 0.001) positively and significantly affect suicidal behaviours. In turn, self-esteem has a significant and negative effect (β = -0.51; p < 0.001) on suicidal behaviours. Self-esteem moderates the relationship between disengagement and suicidal behaviours (B = -0.12; p < 0.001) and the relationship between exhaustion and suicidal behaviours (B = -0.11; p < 0.001), representing an essential variable for future lines of research, namely on the role of self-esteem in preventing burnout and suicidal behaviours in professionals from other professional areas.

Suicidal Behaviour as an Emerging Factor in Female Victims of Gender-Based Violence within a Relationship: An Exploratory Study

Intimate partner violence (IPV), in addition to being an important public health problem, is a risk factor for suicidal behaviour (SB). The objective of this study was to explore the risk of suicidal behaviour associated with the different forms of abuse and the consequences derived from it. This exploratory study was conducted on a sample of women who experienced IPV (N = 70) in the Extremadura Region (Spain). Demographic factors, abuse experience, suicidal ideation (SI), suicidal communication (SC), and suicide attempts (SAs) were analysed according to the type of abuse. We found that a very high prevalence of psychological violence (IPVp) was accompanied, in most cases, by some other type of abuse (IPVp+). Additionally, a significant relationship was found between IPV and SB. Logistic regression revealed a greater risk of SI and SA in the IPVp+ group. The results of this study could be useful to healthcare service professionals in preventing suicidal behaviour.

Commentary: Defining self-harm: how inconsistencies in language persist - a commentary/reflection on Ward and Curran (2021)

Self-harm definition is an important focus of academic research and clinical practice. The precise definition of self-harm has been contested for decades, and current terminology varies across, and sometimes within, countries. This commentary has been written to highlight the problematic use of the term 'deliberate' self-harm (i.e. DSH) and to clarify the terminology currently recommended by clinical agencies in the United Kingdom. Comparisons will be made to other definitions in the field, such as non-suicidal self-injury (NSSI), with the aim of contributing to the worldwide discussion about how we conceptualise, discuss and treat suicidal and non-suicidal behaviours. The commentary concludes by highlighting the findings of Ward and Curran (2021). It is suggested that undiagnosed ADHD may be a potential driver for self-harm, particularly among girls, further highlighting the ongoing challenges in identifying and predicting which youth are at risk for self-harm and suicidal behaviours. Central to this challenge has been the long-standing confusion around the best way to define self-harm.

Proposal for the Inclusion of Tobacco Use in Suicide Risk Scales: Results of a Meta-Analysis

There is an association between smoking and suicide, even though the direction and nature of this relationship remains controversial. This meta-analysis aimed to evaluate the association between smoking and suicidal behaviours (ideation, planning, suicide attempts, and death by suicide). On 24 August 2020, we searched the PubMed, Cochrane library, Scopus, Web of Science, TRIP, and SCIENCE DIRECT databases for relevant articles on this topic. Twenty prospective cohort studies involving 2,457,864 participants were included in this meta-analysis. Compared with never smokers, former and current smokers had an increased risk of death by suicide (relative risk [RR] = 1.31; 95% CI [1.13, 1.52] and RR = 2.41; 95% CI [2.08, 2.80], respectively), ideation (RR = 1.35; 95% CI [1.31, 1.39] and RR = 1.84; 95% CI [1.21, 2.78]), and attempted suicide (RR = 1.27; 95% CI [0.56, 2.87] and RR = 1.71; 95% CI [0.73, 3.97]). Moreover, compared to never smokers, current smoker women (RR = 2.51; 95% CI [2.06-3.04] had an increased risk of taking their own life (Q = 13,591.53; p < 0.001) than current smoker men (RR = 2.06; 95% CI [1.62-2.62]. Furthermore, smoking exposure (former and current smokers) was associated with a 1.74-fold increased risk (95% CI [1.54, 1.96]) of suicidal behaviour (death by suicide, ideation, planning, or attempts). Thus, because of the prospective relationship between smoking and suicidal behaviours, smoking should be included in suicide risk scales as a useful and easy item to evaluate suicide risk.

Case manager perceptions of emergency department use by patients with non-fatal suicidal behaviour

Repeat presentations to the emergency department (ED) for non-fatal suicidal behaviour (NFSB) are common in Australia and overseas. The challenges faced by mental health services in managing this sub-group of patients have not been fully explored. In this qualitative study, we consider how case managers view frequent ED use by patients with NFSB. Individual interviews with case managers were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Four main themes emerged: a logical place to go; not a lot of benefit from an ED visit; focus on managing risk; and building a life outside of the ED. The case managers noted that patients with NFSB tend to have complex presentations that are challenging to address in the ED. The focus tends to be on assessment of risk with referral to community support agencies. The findings point to the need to identify more intensive care options that support patients to reduce their dependency on the ED. Insights gleaned from the study have implications for those working with NFSB patients.

Trends and patterns of suicidal behaviour in Nigeria: Mixed-methods analysis of media reports from 2016 to 2019

BACKGROUND

Media coverage of suicides in Nigeria appears to be explicitly descriptive and deviates from the recommended best practice. Despite these shortcomings, verifiable information provided by these media outlets could arguably, at the minimum, mirror the reality of the trends and patterns of suicidal behaviour in Nigeria.

AIM

This study aimed to analyse the trends and patterns of suicidal behaviour in Nigeria using media reports from 2016 to 2019. We examined the effect of gender and age groups on these trends and patterns of suicidal behaviour.

SETTING

The study was carried out in Nigeria.

METHODS

Qualitative content analysis was used to assess the content of each verifiable suicide event. In total, 336 verified suicide-related events were selected from 4365 media reports. Quantitative data were collected on age, gender, type of suicidal behaviour, method, place and motivation for suicidal behaviour. Data were analysed using the Statistical Package for the Social Sciences software. Fisher's exact test was used to examine the association between gender, age groups and other variables. p-value was set at ≤ 0.05.

RESULTS

Completed suicide was the most common reported suicidal behaviour. Hanging was the dominant reported method, followed by poisoning. Significant gender differences were observed between age groups (p < 0.001) and methods of suicidal behaviour (p < 0.001). Also, significant age differences were observed between the methods of suicidal behaviour (p < 0.001), places (p < 0.001) and motivations for suicidal behaviour (p < 0.001).

CONCLUSION

The study confirms that there are gender and age differences in the trends and patterns of suicidal behaviour in Nigeria.

A Comparison of Presentations with Self-Harm to Hospital in Lithuania and Ireland

Suicide is a serious problem globally, especially in Europe, with suicide rates varying between different countries. Self-harm is a known risk factor for dying by suicide and represents an opportunity to intervene in order to treat any associated mental illness and reduce risk. This study aimed to compare the characteristics of people presenting to hospital with self-harm at two clinical sites: Galway, Ireland and Kaunas, Lithuania. Data were obtained from the services’ database and anonymised for analysis. Over a 5-month period, 89 patients presented with self-harm at the Lithuanian site and 224 patients presented with self-harm at the Irish site. This study found significant differences in presentation, diagnosis and treatment between the two sites. All patients at the Lithuanian site were admitted to psychiatry, compared to 22% of patients at the Irish site (p < 0.001). In Lithuania, the main clinical diagnoses were adjustment disorder (37.1%) and major depression (20.2%), compared to substance misuse being the main clinical diagnosis (33.8%) in Ireland (p < 0.001). There were significant differences in the prescription of psychotropic medications (which were three times more commonly prescribed at the Lithuanian site) after controlling for age, gender and psychiatric history (p < 0.001). Further research is required to understand the cultural context behind and further association between hospitalisation and future death by suicide.

Mental Health Disturbances and Related Problems in Italian University Medical Students from 2000 to 2020: An Integrative Review of Qualitative and Quantitative Studies

Background and objectives: The presence of mental health problems in the population of medical students in Italy has been evaluated in several cross-sectional studies, which have used different methodologies and study designs. However, a global overview of the prevalence of mental health problems in Italian medical students is not available, although this would be essential for promoting preventive strategies and supportive treatments. Materials and Methods: An integrative review aiming to describe the prevalence of mental health problems in Italian medical students has been performed. Results: The most relevant findings are the high prevalence of substance use, in particular alcohol and nicotine, and of depressive and anxiety disorders in Italian medical students. In particular, substance use ranges from 13 to 86%, which is higher compared to Italian students coming from other faculties. Italian medical students show a high rate of smoking and of depressive symptoms of about 20%. Conclusions: Our findings highlight the need to develop appropriate supportive interventions for the medical student population, which are rarely provided and implemented among the routine activities of Italian medical universities. A relevant aspect to be considered is the stigma and anticipated discrimination attached to mental disorders, which reduce the help-seeking process in medical students.

Suicidal behaviours and moderator support in online health communities: protocol for a scoping review

INTRODUCTION

Suicidal ideation and suicidal behaviours are common yet complex mental health presentations that can pose significant challenges for health professionals. The inability to accurately predict the individuals who may move from experiencing suicidal ideation and associated behaviours, to completing suicide, presents one such challenge. This can make it difficult to provide interventions and support to those most in need. Online health communities are one possible source of support for individuals who experience suicidal ideation and behaviours. These communities are becoming an increasingly popular way of accessing support, often with life-saving consequences. Within online communities, support is offered by various individuals including, in some instances, health professionals from various backgrounds, who work as online health community moderators. Given the growth of online communities and the increasing number of health professionals working as moderators, this scoping review seeks to map the literature that has focused on health professionals working as online community moderators, who interact with members experiencing suicidal ideation and behaviours. Mapping the existing literature offers benefits to both research and practice by identifying gaps in the research and providing a beginning knowledge base of current practice that can inform the training and development of health professionals working as community moderators.

METHODS AND ANALYSIS

This scoping review will follow the methodological framework of Arksey and O'Malley, later adapted by Levac et al. To ensure appropriate rigour, this protocol uses the 20-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses and extension for Scoping Reviews. Literature will be identified using a search strategy developed in consultation with a specialist research librarian at the university where the researchers are employed. Ten multidisciplinary databases will be independently searched by two researchers, and both researchers will screen for inclusion, and undertake the data extraction. The first author will perform a quality assessment of the articles that are selected for inclusion. A second researcher will complete a random audit of 20% of the included articles to assess for quality and suitability in answering the research questions. The first author will complete the analysis and synthesis of the data. A numerical and narrative synthesis of the included studies will be provided.

ETHICS AND DISSEMINATION

The scoping review has been deemed as being exempt from ethical review as no data will be collected from human participants. The results of the scoping review may be published in a peer-reviewed journal, thesis, presented at relevant conferences, and shared with relevant knowledge users.

Factors that contribute to psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses: qualitative study

BACKGROUND

Suicide is a leading cause of premature death in people with a diagnosis of schizophrenia. Although exposure to stressors can play a part in the pathways to death by suicide, there is evidence that some people with a diagnosis of schizophrenia can be resilient to the impact of suicide triggers.

AIMS

To investigate factors that contribute to psychological resilience to suicidal thoughts and behaviours from the perspectives of people with a diagnosis of schizophrenia.

METHOD

A qualitative design was used, involving semi-structured, face-to-face interviews. Twenty individuals with non-affective psychosis or schizophrenia diagnoses who had experience of suicide thoughts and behaviours participated in the study. The interviews were audio-recorded, transcribed verbatim and examined using inductive thematic analysis.

RESULTS

Participants reported that psychological resilience to suicidal thoughts and behaviours involved ongoing effort. This ongoing effort encompassed: (a) understanding experiences (including reconciliation to mental health experiences and seeking reasons to live), (b) active behaviours (including talking to people and keeping occupied), and (c) relationship dynamics (including feeling supported by significant others and mental health professionals).

CONCLUSIONS

Psychological resilience was described as a dynamic process that developed over time through the experiences of psychosis and the concomitant suicidal experiences. Psychological resilience can be understood using a multicomponential, dynamic approach that integrates buffering, recovery and maintenance resilience models. In order to nurture psychological resilience, interventions should focus on supporting the understanding and management of psychosis symptoms and concomitant suicidal experiences.

DECLARATION OF INTEREST

None.

Carer insights into self-harm in the very old: A qualitative study

OBJECTIVE

To examine the insights of carers to better understand self-harm in their older relatives.

METHODS

An in-depth interview was conducted with the nominated relative/friend (carer) of a person over 80 who had self-harmed within the last month. Carer interpretation and experience of the self-harm and clinical care were explored qualitatively. Audio recordings were transcribed and the content thematically analyzed using N-VIVO.

RESULTS

Thirty-two carers of 30 older people who self-harmed were interviewed. Physical, social, and psychological issues were identified as contributory to self-harm. Themes relating to the perceived barriers to seeking help included "they can't communicate," "suicide and secrets," and "invalidation." Themes for the intent of self-harm were "attention seeking" and "wanting to die." Themes which emerged for consequences of self-harm for carers were "anger," "guilt and self-blame," and "it made us ill." Themes for solutions to address the underlying factors leading to self-harm were "more practical support and structure," "improving communication," "removing means of self-harm," "advance care directives as a solution for suffering," and "ignoring self-harm." Clinical care themes were "shared shame and stigma," "safety and supervision vs being locked up," "clinicians dismissing the carer," and "relief and support."

CONCLUSIONS

Validation of carer perspectives and understanding family dynamics may improve communication at various system levels and inform interventions for older persons, concurrently support families, and potentially reduce risk of repeat self-harm. Good care must be holistic, be person-centred, and relieve carer burden. A shared understanding and psychotherapeutic approaches to management of self-harm in late life should be considered.

Suicidal behaviours among Chinese adolescents exposed to suicide attempt or death

AIMS

Suicidal behaviours in adolescents are prevalent and multifactorial. This study was conducted to examine the associations between exposure to suicide attempt (ESA) or suicide death (ESD) and suicidal behaviours in a large sample of Chinese adolescents.

METHODS

Participants included for the analysis were 11 831 adolescent students who participated in the baseline survey of the Shandong Adolescent Behavior and Health Cohort (SABHC). Participants were sampled from five middle and three high schools in three counties of Shandong province, China. A self-administered structured questionnaire was used to collect data on demographics, behavioural and emotional problems, family environment, suicidal behaviours (suicidal thought, plan and attempt), and history of ESA or death of a family member, relative, friend or close acquaintance. Based on the sources of exposure, the participants were divided into four groups: non-exposure, exposure from relatives only, exposure from friends/close acquaintances only (EFO) and exposure from both relatives and friends (ERF). Logistic regressions were used to examine the associations between ESA or ESD and suicidal behaviours.

RESULTS

Mean age of the participants was 14.97 ± 1.46 years and 50.9% were boys. Of the participants, 9.4% reported having ESA, and 6.6% reported having ESD. The prevalence rates of suicidal behaviours were significantly higher in adolescents who had been exposed to suicide attempt or death than those who had not. Multivariate logistic regressions showed that ESA and ESD were both significantly associated with increased risks of suicidal thought (ESA: OR = 1.96, 95% CI = 1.66-2.31; ESD: OR = 1.59, 95% CI = 1.31-1.94), plan (ESA: OR = 2.37, 95% CI = 1.84-3.05; ESD: OR = 1.62, 95% CI = 1.18-2.23) and attempt (ESA: OR = 2.73, 95% CI = 1.92-3.89; ESD: OR = 1.82, 95% CI = 1.18-2.82), respectively. When participants were exposed to suicide attempt, ERF and EFO groups had significantly higher risks of suicidal thought (ERF: OR = 2.61, 95% CI = 1.28-1.64; EFO: OR = 1.96, 95% CI = 1.64-2.36), plan (ERF: OR = 3.72, 95% CI = 2.04-6.78; EFO: OR = 2.31, 95% CI = 1.74-3.01) and attempt (ERF: OR = 4.83, 95% CI = 2.30-10.17; EFO: OR = 2.57, 95% CI = 1.73-3.81), respectively.

CONCLUSIONS

ESA or ESD was associated with increased risks of suicidal behaviours in adolescents. Exposure to suicidal behaviours of relatives and friends/close acquaintances appeared to have different influence on adolescent suicidal behaviours. Further research is warranted to examine the biological and psychosocial mechanisms between suicidal exposure and subsequent suicidal behaviours in adolescents.

Why Do the Very Old Self-Harm? A Qualitative Study

OBJECTIVES

To examine the perspectives of people aged 80 years or older who self-harmed regarding their reasons for self-harm and its consequences, and their perceptions of care.

DESIGN

A qualitative study using in-depth interviews.

SETTING

Participants were recruited from two teaching hospitals and associated community services.

PARTICIPANTS

People aged 80 years or older who had self-harmed within the previous month.

METHODS

Structured psychiatric assessment including cognitive testing, DSM-5 diagnosis, and an in-depth qualitative interview focusing upon the reasons for and consequences of self-harm. Narrative enquiry was used to guide the discussion. All interviews were undertaken by a geriatric psychiatrist, audio recorded, transcribed verbatim, and subjected to thematic analysis using N-VIVO.

RESULTS

Themes that emerged for the reasons for self-harm included "enough is enough"; "loneliness"; "disintegration of self"; "being a burden"; "cumulative adversity"; "hopelessness and endless suffering"; "helplessness with rejection"; and "the untenable situation". Themes for the consequences of self-harm were "becoming engaged with or distanced from family"; "the problem was solved"; "gaining control"; "I"m worse off now"; "rejection by health professionals"; and "tension in the role of the inpatient clinical environment".

CONCLUSIONS

Self-harm may communicate a need that cannot otherwise be expressed. An individualized person-centered approach is required to respond to self-harm, including a combination of practical, medical, and psychological approaches as indicated. Involvement of families in the process of understanding the meaning of and responding to self-harm through education and family therapy, as well as education of healthcare professionals beyond risk factor notation may be indicated.

Self-rated health among Greenlandic Inuit and Norwegian Sami adolescents: associated risk and protective correlates

Objectives

Self-rated health (SRH) and associated risk and protective correlates were investigated among two indigenous adolescent populations, Greenlandic Inuit and Norwegian Sami.

Design

Cross-sectional data were collected from “Well-being among Youth in Greenland” (WBYG) and “The Norwegian Arctic Adolescent Health Study” (NAAHS), conducted during 2003–2005 and comprising 10th and 11th graders, 378 Inuit and 350 Sami.

Methods

SRH was assessed by one single item, using a 4-point and 5-point scale for NAAHS and WBYG, respectively. Logistic regressions were performed separately for each indigenous group using a dichotomous measure with “very good” (NAAHS) and “very good/good” (WBYG) as reference categories. We simultaneously controlled for various socio-demographics, risk correlates (drinking, smoking, violence and suicidal behaviour) and protective correlates (physical activity, well-being in school, number of close friends and adolescent–parent relationship).

Results

A majority of both Inuit (62%) and Sami (89%) youth reported “good” or “very good” SRH. The proportion of “poor/fair/not so good” SRH was three times higher among Inuit than Sami (38% vs. 11%, p≤0.001). Significantly more Inuit females than males reported “poor/fair” SRH (44% vs. 29%, p≤0.05), while no gender differences occurred among Sami (12% vs. 9%, p≤0.08). In both indigenous groups, suicidal thoughts (risk) and physical activity (protective) were associated with poor and good SRH, respectively.

Conclusions

In accordance with other studies of indigenous adolescents, suicidal thoughts were strongly associated with poorer SRH among Sami and Inuit. The Inuit–Sami differences in SRH could partly be due to higher “risk” and lower “protective” correlates among Inuit than Sami. The positive impact of physical activity on SRH needs to be targeted in future intervention programs.

Media roles in suicide prevention: a systematic review

The aim of the current systematic review was to monitor and provide an overview of the research performed about the roles of media in suicide prevention in order to find out possible effects media reporting on suicidal behaviours might have on actual suicidality (completed suicides, attempted suicides, suicidal ideation). The systematic review was performed following the principles of the PRISMA statement and includes 56 articles. Most of the studies support the idea that media reporting and suicidality are associated. However, there is a risk of reporting bias. More research is available about how irresponsible media reports can provoke suicidal behaviours (the 'Werther effect') and less about protective effect media can have (the 'Papageno effect'). Strong modelling effect of media coverage on suicide is based on age and gender. Media reports are not representative of official suicide data and tend to exaggerate sensational suicides, for example dramatic and highly lethal suicide methods, which are rare in real life. Future studies have to encounter the challenges the global medium Internet will offer in terms of research methods, as it is difficult to define the circulation of news in the Internet either spatially or in time. However, online media can provide valuable innovative qualitative research material.