Australian Suicide Prevention Research Articles

Psychotropic and other medicine use at time of death by suicide: a population-level analysis of linked dispensing and forensic toxicology data.

To determine the numbers and types of medicines dispensed around the time of death to people who die by suicide; to compare the medicines recently dispensed and those recorded in post mortem toxicology reports. Analysis of linked National Coronial Information System (NCIS) and Pharmaceutical Benefits Scheme (PBS) data from the Australian Suicide Prevention using Health Linked Data (ASHLi) study, a population-based case series study of closed coronial cases for deaths of people in Australia aged ten years or more during 1 July 2013 - 10 October 2019 deemed by coroners to be the result of intentional self-harm. Proportions of people to whom medicines were dispensed around the time of death, by medicine group, class, and specific medicine; comparison of medicines recently dispensed and those detected by post mortem toxicology. Toxicology reports were available for 13 541 of 14 206 people who died by suicide (95.3%; 10 246 men, 75.7%); poisoning with medicines contributed to 1163 deaths (8.6%). At least one PBS-subsidised medicine had been dispensed around the time of death to 7998 people (59.1%). For three medicine classes, the proportions of people in whom the medicines were detected post mortem and their death was deemed medicine-related were larger for those without records of recent dispensing than for people for whom they had been dispensed around the time of death: antidepressants (17.7% v 12.0%), anxiolytics (16.3% v 14.8%), and sedatives/hypnotics (24.3% v 16.5%). At least one recently dispensed medicine not detected post mortem was identified for 6208 people (45.8%). A considerable proportion of people who died by suicide were not taking psychotropic medicines recently dispensed to them, suggesting non-adherence to pharmacotherapy, and a smaller than expected proportion were using antidepressants. Conversely, medicines that had not recently been dispensed were detected post mortem in many people for whom poisoning with medicines was a contributing factor, suggesting medicine stockpiling.

Wesley LifeForce Suicide Prevention Gatekeeper Training in Australia: 6 Month Follow-Up Evaluation of Full and Half Day Community Programs.

Background and Objective: Wesley Mission LifeForce training is an Australian suicide prevention gatekeeper program which has not been formally evaluated. The aims of this evaluation were to (1) determine the short- and medium- term impacts of the training on worker capabilities (perceived and declarative knowledge), attitudes, and reluctance to intervene measures; and (2) compare the impact of the half and full day workshops on these measures.Method: 1,079 Australian community workers of diverse professional backgrounds completed a pre-workshop questionnaire as part of registration for the Wesley LifeForce suicide prevention training between 2017 and 2019. Of these, 299 participants also completed the post workshop questionnaires (matched sample). They attended either half day (n = 97) or full day workshops (n = 202) and completed also a 3- and 6- month follow-up questionnaire. We used linear mixed-effect modeling for repeated measures to analyze data.Results: LifeForce training participants experienced an increase in perceived capability, declarative knowledge, more positive attitudes and reduced reluctance to intervene, at least in the short term. The program is particularly well targeted for community gatekeepers with no prior training, albeit those with prior training in this study also experienced positive and significant gains on most measured constructs.Conclusions: We found evidence of effectiveness of the Wesley LifeForce training over time, without difference between the short (half day) and longer (full day) formats of delivery. Nevertheless, the latter format offers skills-based and skills rehearsal opportunities, the impacts of which we were unable to measure in this evaluation and should be estimated in the future.

Australian Suicide Prevention using Health-Linked Data (ASHLi): Protocol for a population-based case series study

IntroductionIn Australia, suicide is the leading cause of death for people aged 15–44 years. Health professionals deliver most of our key suicide prevention strategies via health services, but other efficacious...

Development of an evidence-based Evaluation Toolkit for suicide prevention networks in regional Australia.

Suicide is a global public health concern, particularly for those living in rural, regional and remote areas. Despite numerous prevention initiatives, suicide continues to impact individuals, families and communities. Suicide prevention networks are an innovative, community-based approach to addressing suicide within local government areas. Anecdotally, suicide prevention networks make an important contribution to suicide prevention, yet frameworks for evaluating their impact do not exist. The purpose of this project was to develop an Evaluation Toolkit to be used by suicide prevention networks throughout South Australia to monitor their impact. Participatory action research was used to work with one suicide prevention network in regional South Australia to co-design and produce the Evaluation Toolkit. One regional South Australian town, with an established suicide prevention network. The development of an Evaluation Toolkit, to allow all South Australian suicide prevention networks to measure their impact in a consistent manner. The Evaluation Toolkit has been made freely available in electronic form and as a hard copy booklet for use by all South Australian suicide prevention networks. The purpose of this project was to develop the Evaluation Toolkit. Formal assessment of its usability and effectiveness is yet to be undertaken, but preliminary anecdotal evidence indicates aspects of the Evaluation Toolkit are useful, especially the questionnaire templates that can be adapted and used to evaluate various community events. Participatory action research is a useful method for working with community-based suicide prevention groups.

Do Australian media apply recommendations when covering a suicide prevention campaign?

Purpose Media reporting and portrayals of mental illness and suicide can play an important role in shaping and reinforcing community attitudes and perceptions. Depending on the content, a report about suicide can have either a negative (Werther-) or a positive (Papageno-) effect. Evidence-informed recommendations for the reporting of suicide in Australia are provided under the Mindframe initiative. The purpose of this paper is to assess the application of these recommendations in broadcasts associated with one of the largest national campaigns to promote suicide prevention, the R U OK? Day, a yearly campaign of the Australian suicide prevention charity R U OK? Design/methodology/approach The sample consisted of 112 (32 TV, 80 radio) Australian broadcasts discussing the R U OK? Day suicide prevention campaign during the month preceding the 2015 campaign and on the national R U OK? Day itself. Broadcasts were coded for medium (TV or radio), content (suicide focus, mental illness focus or both) and consistency with Mindframe recommendations. Findings Over 97 per cent of broadcasts used language consistent with Mindframe recommendations. None of the broadcasts used images that negatively portrayed mental illness or suicide; there were no instances of using mental illness to describe a person’s behaviour; and no sensationalizing or glamorising terminology was used in the broadcasts. However, less than 40 per cent of the broadcasts included help-seeking information (e.g. helplines) and some of the broadcasts used negative or outdated terminology (e.g. “commit” suicide; “suffering” from mental illness). Originality/value The present study is the first to examine consistency with reporting recommendations around a national suicide prevention campaign (R U OK? Day). The results can steer improvements in current reporting and inform strategies to optimise future reporting.

The construction of people in suicide prevention documents

Suicide is a significant issue worldwide and despite comprehensive prevention activities, suicide stigma remains. To explore this issue, we used critical discourse analysis to examine how Australian suicide prevention documents (n = 8) constructed people living with thoughts of suicide. We found that risk and biomedical discourses dominated, with people experiencing suicide ideation constructed as dangerous, different, lacking coping skills, and burdensome. We propose that future suicide prevention activities address potentially stigmatizing language, broaden support and advocacy options, and meaningfully include people with lived experience of suicidal ideation or behavior in the development of policy and interventions.

Dealing with Ethical Concerns in Suicide Research: A Survey of Australian Researchers.

Given the increasing trend in suicide mortality and its burden on individuals, families and communities, ethically sound research is crucial to improve the prevention of suicidal behaviour. However, few studies have looked at the experiences of researchers in obtaining ethics approval for their studies. This study addressed this gap by investigating researchers’ experiences in obtaining ethics approval and how they dealt with the concerns raised by ethics committees. Respondents were recruited from September to November 2018 through the Australian Suicide Prevention Research Leaders Network, and 33 respondents (35%) completed the study survey, comprising forced-choice and open-ended questions. Respondents most commonly reported concerns from ethics committees regarding potential harm to participants and researchers’ responsibilities to participants within the context of intervention and evaluation studies. Most researchers modified their ethics application and/or consulted with their ethics committee to reply to the concerns raised. Most respondents perceived the impact of the modification as positive or neutral. The study concludes that researchers may anticipate potential concerns of ethics committees. Improved understanding of how ethics committees work and dialogue between researchers and ethics committees should sustain the quality in suicide-related research.

Research Priorities in Suicide Prevention: Review of Australian Research from 2010⁻2017 Highlights Continued Need for Intervention Research.

Suicide is a major public health concern in Australia and globally, requiring targeted research efforts to build the evidence base for its effective prevention. We examined current and future priorities in Australian suicide prevention research during the period 2010–2017, and compared these to 1999–2006 baseline data. We classified current research priorities in terms of the type of research published in 424 journal articles and 36 grants and fellowships funded during 2010–2017. A questionnaire administered to 390 stakeholders identified future research priorities. The total number of suicide prevention focussed journal articles and the value of funded grants increased dramatically. Congruent with baseline data, current research priorities in 2010–2017 reflected a strong emphasis on epidemiological studies, while funding for intervention studies declined. This is despite the fact that stakeholders continually identified intervention studies as being the highest future research priority. If we are to make real advances in suicide prevention, we need to know what works, and identify and test effective interventions. This study highlighted the existing dearth and continued need for intervention research. Mechanisms to support future intervention research in suicide prevention are likely to lead to significant gains in knowledge and population health.

Research priorities in suicide prevention: A qualitative study of stakeholders’ views

The current study sought to inform priority setting in Australian suicide prevention research, by seeking stakeholders' views on where future priorities might lie. Three group interviews were conducted with a total of 28 participants. Group interview participants stressed that priority should be given to evaluating the efficacy of specific interventions and examining the response of the health and community service systems. They felt that the epidemiological profile of suicidal individuals had been explored, at least with respect to rates and individual-level risk factors, and that the above evaluative activities should focus on groups identified as having particularly high levels of risk. Most saw limited value in continuing to explore individual-level risk factors ad infinitum, and felt that the time had come to move on to considering wider societal influences on suicide and individual-level protective factors. Many felt that evaluation efforts should employ mixed methods, should be multidisciplinary and should be relevant to the Australian context. They also argued that there was scope for increasing the utility of research findings by communicating them in a manner that would enable them to be utilised by policy-makers, planners and practitioners. Several called for a more cohesive framework for suicide prevention that could guide suicide prevention research. The current study provides some guidance with respect to the direction Australia's suicide prevention research agenda should take. A prioritydriven approach to suicide prevention research will ensure that the research endeavour provides the most useful information for those whose day-to-day work involves trying to prevent suicide.

Research Priorities in Suicide Prevention in Australia

This project sought to inform priority setting in Australian suicide prevention research, by empirically examining existing priorities and by seeking stakeholders' views on where future priorities might lie. Existing priorities were examined via reviews of Australian literature published and grants funded during the life of the National Suicide Prevention Strategy (1999-2006). Stakeholders' views of future priorities were elicited via a questionnaire administered to 11 groups comprising 231 individuals with an interest in suicide prevention. The study identified 263 journal articles and 36 grants. The journal articles most commonly reported on studies of descriptive epidemiology, while the grants tended to fund intervention studies. Both gave roughly equal weight to completed and attempted suicide, and gave little emphasis to studies of suicide methods. Young people were the most frequently-researched target group, with people with mental health problems and people who had attempted suicide or deliberately self-harmed also receiving attention. Stakeholders indicated that emphasis should be given to intervention studies, and that completed suicide and attempted suicide are both important. In terms of suicide method, they felt the focus should be on poisoning by drugs and hanging. They had mixed views about the target groups that should be afforded priority, although young people and people with mental health problems were frequently ranked highly. This paper presents a picture of the current focus with regard to suicide prevention research, identifying some areas where there are clear gaps and others where relatively greater efforts have been made. By combining this information with stakeholders' views of where future priorities should lie, the paper provides some guidance as to the shape a future suicide prevention research agenda for Australia should take. A strategic approach to suicide prevention research will help fill internationally-identified gaps in knowledge about what works and what doesn't work in suicide prevention.

A review of 156 local projects funded under Australia’s National Suicide Prevention Strategy: Overview and lessons learned

This paper presents an overview of 156 local suicide prevention projects funded under Australia's National Suicide Prevention Strategy (NSPS), and describes lessons elicited from a content analysis of the projects' progress and final reports. The purpose of the analysis was to maximize gains in Australian suicide prevention activities by highlighting promising processes and impacts and minimise repetition of less successful elements. The projects targeted 11 groups (with the most common being young people, Aboriginal and Torres Strait Islander people and people in rural/remote areas); occurred in various settings (with community-based projects being particularly popular); and employed different approaches (with training and support for health/community professionals or carers being favoured, along with public health interventions aimed at enhancing well-being and building resilience). Certain processes augured well for project success, including: understanding contextual factors; investigating participants' needs; drawing on sound evidence; developing multi-faceted strategies; garnering stakeholder support; and employing capable staff. The projects achieved improvements in knowledge about risk and protective factors for suicide, social connectedness and mental health literacy, and reductions in depressive symptomatology. Projects' sustainability was constrained by their short-term funding. These findings are discussed in the context of the NSPS entering a new funding phase.