Intervention in suicidal ideation and suicide prevention: Experiences and perceptions of a group of Portuguese psychologists

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

Comparison of the factors for suicidal ideation and suicide attempt: a comprehensive examination of stress, view of life, mental health, and alcohol use.

Suicide Prevention in an International Context.

Introduction Globally, over 700,000 people die by suicide yearly, and 77% of the suicide global burden is reported in Low middle-income countries, including Nigeria (1). Community pharmacists are often the most visited healthcare providers for locals in Nigeria. However, there is sparse knowledge about their contributory role in suicide prevention (2). Aim To explore key informants’ perspectives on the potential contribution of community pharmacists in Nigeria to suicide prevention and gain insight into the potential barriers and facilitators in incorporating a suicide prevention programme within community pharmacies. Method Online semi-structured interviews were conducted with global key informants. The key informants were recruited based on their expertise in suicide prevention, public health, mental health, and pharmacy practice from low- and high-income countries. In addition, key informants were either author from literature reviews or referred by the informants. All key informants were contacted through emails, agreed informants gave both verbal and written consent. The topic guide questions were modified according to each key informant’;s professional role and country. The recruitment and interviews were done from March 2022 to September 2022. The interviews were audio, and video recorded, transcribed verbatim and thematically analysed using NVivo software.Codes were generated by the lead researcher and reviewed by the study team. Results A total of 22 key informants consisting of 6 pharmacists, 5 researchers, 4 mental health consultants, 2 policy makers, 2 cognitive behavioural therapists, 2 psychiatrists and 1 suicide and self-harm analyst with different geographical background participated in this study. Each key informant presented perspective on how suicide prevention effort is being handled in their country and how the potential community pharmacist’s role in Nigeria could work. The major themes identified are :(i) The need for a suicide prevention programme in community pharmacies, and this includes (ii) Restricting access to means. This could be achieved by (iii) Education and Training, (iv) Pharmacy service reimbursement and (v) a referral system with other health professionals. (vi) stigma and (vii) pharmacy environment were highlighted as barriers. Conclusion Global Key informants were open to the community pharmacist’;s role in suicide prevention, expecting it would help fill the psychiatric professional gap in Nigeria’;s mental health system. However, some expressed concerns about community pharmacists’ lack of knowledge and awareness in this area and where they could distinctively fit in suicide prevention strategies. Perceptions of stigma underpinned much of key informants’ discussion. All key informants indicated the high existence of cultural and professional stigma and its impact on suicide prevention. This is the first study to explore a broad global perspective on community pharmacists’ role in suicide prevention. However, some key informants are registered pharmacists, and others have a particular interest in suicide prevention and training, thus may be biased towards community pharmacists’ role in suicide prevention. To further explore the practical implication of any recommendations about this role, our identified themes will help to develop our Delphi study to determine consensus on the scope of the future contribution of community pharmacists to suicide prevention efforts in Nigeria.

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.

Introduction: In Flanders, the Flemish Pharmacists Network (VAN), in collaboration with the Flemish Centre of Expertise in Suicide Prevention (VLESP) will finish the second and final phase of the project on suicide prevention through expertise promotion in public pharmacies at the end of March 2024. This initiative is part of the third Flemish action plan in suicide prevention that aims to reduce deaths by suicide in Flanders by 10 % by 2030 compared to 2022. Background: Suicidal thoughts are a serious and complex issue, often with no single root cause or explanation. Nor is there one simple way to prevent people from having them. Through scientific research and experience, much has already been uncovered about the origins and process of suicide as well as some effective prevention strategies. Reducing access to means of suicide is an effective prevention method. Pharmacists can play an important role in suicide prevention as gatekeepers. Who is it for? Pharmacies are low-threshold and an easily accessible gateway keepers to healthcare for a lot of citizens. The goal is for pharmacists to actively question their patients about possible suicidal ideation and, if necessary, refer them to a health professional who can provide further help. Who did you involve and engage with? In 2022, VAN launched the project among Flemish pharmacists in collaboration with VLESP and with the support of the Flemish government. What did you do? The project started its first phase in 2022. It included a literature review, a needs assessment and the creation, launch and evaluation of the e-learning as a tool for gatekeeper training. In the second phase, participating pharmacies were mentored in a variety of methods to have productive conversations in their pharmacies in the context of suicide prevention. These conversations were measured qualitatively and quantitatively. What results did you get? A survey of the first phase showed a need and willingness of expertise improvement among participating pharmacists. They indicated their preference of an e-learning to learn the necessary skills. Results from the pre and post test of the e-learning showed promising results for the e-learning as gatekeeper training. In the second phase, the number of conversations about suicide in pharmacies was measured, providing further insight into the number of conversations with patients from a vulnerable target group or with a history of suicidal thoughts. In addition, the reason for the conversation, medication use and concrete preventive actions taken were also mapped out. It was also measured how long each conversation lasted on average and where they took place. What is the learning for the international audience? The practical approach taken in this project offers valuable insights for international audiences. The results outline the pharmacist’s potential role in suicide prevention and how this role can be effectively implemented. What are the next steps? Upon completing the final phase of the project in March 2024, a comprehensive report will be prepared for the Flemish government for further implementation in Flanders.

Purpose – The purpose of this paper is to propose that black churches in the USA are best suited to curtail the rising incidence of suicide, and suicide ideation among African-American adolescents. Presently, little is known about the best preventive practices and mental healthcare interventions for the black adolescents assailed by suicide and suicidal ideation. Design/methodology/approach – A review of the extant literature was conducted to understand and synthesize the current knowledge base about suicide rates among African-American adolescents. To retrieve and review relevant literature that focussed on suicide among African-American adolescents and the preventive roles of black churches the authors searched the following databases: PsychINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Social Work abstracts, and Google Scholar. Findings – Findings indicate that black churches could implement, and profusely replicate the lay health advisors and HAVEN models to successfully mitigate the rate of suicide among black adolescents. In addition it was found that the gatekeeper suicide prevention program model also holds promise for suicide prevention among black adolescents in black churches. Research limitations/implications – The result of this research synthesize is limited to African-American adolescents and may not be generalizable to other minority adolescents’ experiencing suicidal challenges. Furthermore, future research should utilize qualitative research methodologies to document lived experiences of African-American adolescents who are survivors of suicide attempts with a view to preventing suicide and suicidal ideation among black adolescents. Originality/value – Healthcare professionals, and policy makers, are provided a panoramic view of culturally competent and spiritually sensitive prevention interventions within black churches that are most appropriate for reducing suicide rates among minority black adolescents.

Implementation Science in Suicide Prevention.

Clients Who Threaten Suicide—and Our Responsibilities

The study aimed to explore the suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural community in Hanoi, Vietnam. Semi-structured interviews were conducted, in a community setting, with 19 suicide attempters aged 15-24 who had been consecutively hospitalized in an intensive care unit. In 12 of 19 cases, the first pressing, distinct and constant suicidal thoughts appeared less than one day before the suicide attempt in question. However, distress and mild, fleeting suicidal thoughts had been present up to six months before the suicide attempt in 16 cases. Five respondents had a suicide plan one to three days before attempting suicide. Altogether, 13 engaged in some form of suicidal communication before their attempt. This communication was, however, difficult for outsiders to interpret. Twelve of the respondents were victims of regular physical abuse and 16 had suffered psychological violence for at least one year before attempting suicide. Eighteen of the respondents used pesticides or raticides in their suicide attempts. None sought advice or consultation in the community despite long-standing psychosocial problems. The strategy of reducing the availability of suicide means (e.g., pesticides or raticides) in Asian countries should be complemented with a long-term suicide-preventive strategy that targets school dropouts and domestic violence, and promotes coping abilities and communication about psychological and social problems as well as recognition of signs of distress and suicidal communication.

Background and Objective Suicide attempts are 10-20X more common than completed suicide and an important risk factor for death by suicide, yet most people who attempt suicide do not die by suicide. The process of recovering after a suicide attempt has not been well studied. The Reasons to go on Living (RTGOL) Project, a narrative web-based study, focuses on experiences of people who have attempted suicide and made the decision to go on living, a process not well studied. Narrative research is ideally suited to understanding personal experiences critical to recovery following a suicide attempt, including the transition to a state of hopefulness. Voices from people with lived experience can help us plan and conceptualize this work. This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. Material and Methods A website created for The RTGOL Project ( www.thereasons.ca ) enabled participants to anonymously submit a story about their suicide attempt and recovery, a process which enabled participation from a large and diverse group of participants. The only direction given was “if you have made a suicide attempt or seriously considered suicide and now want to go on living, we want to hear from you.” The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Over 5 years, data analysis occurred in several phases over the course of the study, resulting in the identification of data that were inputted into an Excel file. This analysis used stories where participants described positive involvement with the mental health system (50 stories). Results Several participants reflected on experiences many years previous, providing the privilege of learning how their life unfolded, what made a difference. Over a five-year period, 50 of 226 stories identified positive experiences with mental health care with sufficient details to allow analysis, and are the focus of this paper. There were a range of suicidal behaviours in these 50 stories, from suicidal ideation only to medically severe suicide attempts. Most described one or more suicide attempts. Three themes identified included: 1) trust and relationship with a health care professional, 2) the role of friends and family and friends, and 3) a wide range of services. Conclusion Stories open a window into the experiences of the period after a suicide attempt. This study allowed for an understanding of how mental health professionals might help individuals who have attempted suicide write a different story, a life-affirming story. The stories that participants shared offer some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers, including immediately after a suicide attempt. Results of this study reinforce that just one caring professional can make a tremendous difference to a person who has survived a suicide attempt.

College students, particularly those in healthcare fields, face an elevated risk of suicidal ideation and depression. Therefore, it is essential to explore how both actual and perceived emotional resources may play a role in suicide prevention within this age group. This study examined (1) whether actual self-focused emotion-regulation ability diminishes suicidal ideation through a decrease in depressive symptoms, and (2) whether perceived self-emotion appraisal moderates this relationship. In 312 healthcare students (209 women) actual self-focused emotion-regulation ability was negatively related to suicidal ideation through depressive symptoms. Furthermore, perceived self-emotion appraisal buffered the relationship between depressive symptoms and suicidal ideation. Findings suggest that perceived self-emotion appraisal may reinforce the adaptiveness of actual self-focused emotion-regulation ability as a protective factor for psychological maladjustment. The results indicate the collaborative ability to regulate one’s emotions coupled with the self-perception of emotion appraisal could effectively alleviate the potential progression of emotional difficulties among healthcare students.

The World Health Organization's report on suicide: a fundamental step in worldwide suicide prevention.

The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China

Suicide amongst Aboriginal and Torres Strait Islander people is a major cause of premature mortality and a significant contributor to the health and life expectancy gap. This study aimed to estimate the prevalence of thoughts of self-harm or suicide in Aboriginal and Torres Strait Islander people attending an urban primary health care service and identify factors associated with these thoughts. Multilevel mixed-effects modified Poisson regression models were employed to analyse three years of data gathered during the annual Aboriginal and Torres Strait Islander health assessments. At their first health assessment, 11.5% (191/1664) of people reported thoughts of suicide or self-harm in the prior two weeks. Having children, participating in sport or community activities or being employed full-time decreased the risk of such thoughts. Conversely, factors relating to social exclusion including homelessness, drug use, unemployment and job insecurity increased the risk of thoughts of self-harm or suicide. Individual clinicians, health services, and policy-makers all have a role in suicide prevention. Clinicians need appropriate training to be able to respond to people expressing these thoughts. Aboriginal and Torres Strait Islander community organisations need sovereignty and self-determination over resources to provide programs that promote cultural connectivity and address social exclusion, thereby saving lives.