National Suicide Prevention Strategy Research Articles

Analysis of Suicide Methods and Substances Influencing the State of Consciousness of Their Victims in Poland.

An integral part of the World Health Organization’s (WHO) mental health action plan for 2013–2020 is suicide prevention, and a 10% reduction in the suicide rate. A key element of the preventive measures taken is, among other things, limiting access to means enabling and facilitating committing suicide. However, this requires detailed knowledge of community suicide patterns and preferences. Unfortunately, such information is not usually collected, and the recorded method of committing suicide is often imprecise and untrue, which means that such knowledge has limited application in presuicidal prophylaxis. The statistical data on suicides recorded as part of the Police Statistics in Poland during the years 2009–2019 was analyzed. The analysis included suicide deaths and suicide attempts, taking into account the suicide methods and substances influencing the state of consciousness of their victims. The number of suicides in Poland in the analyzed period tended to increase. The most common method of suicide was hanging, and alcohol was the substance influencing the state of consciousness of suicide victims. The statistics for 2017–2019 showed the presence of new methods of suicide, such as taking drugs other than hypnotics, intoxication with narcotic drugs, poisoning with designer drugs, suffocation and self-immolation, as well as new psychoactive substances affecting the state of consciousness of victims, i.e., drugs and narcotic drugs. The effectiveness of actions taken in Poland in the field of suicide prevention does not bring the desired effects, as evidenced by growing number of suicides. This low effectiveness is mainly due to the lack of a national suicide prevention strategy. The effectiveness of these activities may be improved by creating a uniform database of suicides, which is a source of reliable information which will allow the taking of actions aimed at limiting the availability of means enabling and facilitating the committing of suicide. The study aimed to analyze the types of suicide methods and substances influencing the state of consciousness of their victims in Poland in the years covered by the study.

Prevalence of suicidal behaviours and its correlates in latvian general population: 2019-2020

IntroductionSuicide is a challanging problem for a global public health and Latvia remains in the list of European countries with the highest rates of suicide deaths. Information about the epidemiology of suicidal behavior is required for suicide prevention strategy development.ObjectivesTo determine the prevalence of suicidal behavior (suicidal ideation, plan, and attempts) and associated factors in Latvian general population.MethodsComputer assisted face-to-face interviews were carried out between November 2019 and March 2020 to gather information on a representative sample of the Latvian adult population (n=2687). The study sample was selected using a stratified random sampling method. The Mini-International Neuropsychiatric Interview (MINI; version 7.0.2) was used to assess suicidality. Multinomial logistic regression was applied.ResultsThere were 1238 males (46.1%) and 1449 females (53.9%) recruited. Mean age of respondents was 49.9 (SD 18.2). According to the MINI, 10.6% (n=285) of respondents reported at least some level of suicidal behaviour during the last month before interview and 7.1% (n=191) had shown current suicidal behaviour at the moment of interview, 4.0% (n=108) of respondents reported about previous suicide attempts. Non-cohabitation status, unfinished primary education and economical inactivity were statistically significant associated factors for suicidal behaviour among men, but only lower level of education was for women.ConclusionsComprehensive national suicide prevention strategy is required for reducing suicidality in Latvia. Special attention should be paid to women with lower education, and economically inactive, unmarried or non-cohabitant men, as well as man with unfinished primary education.

Immediate Impact of a Brief Suicide Prevention Training for Veteran Volunteers

Introduction. The concern that talking about suicide may intensify suicidal ideation is a common fear that has been dispelled by research, yet still lingers in popular consciousness. The aim of the current initiative was to develop a brief suicide prevention training for volunteers in a peer support program for veterans, given that layperson-facing approaches are critical to the U.S. national strategy for suicide prevention. Method. The study team adapted existing pedagogical approaches for use in a brief training and for a veteran population, and implemented the training with five new volunteer groups over 5 months ( N = 45). Results. Anonymous pre- and posttraining questionnaires indicated immediate statistically significant improvements in self-reported preparation to talk openly about suicide, likelihood of asking about suicide, confidence in recognizing warning signs of suicide, and confidence in intervening and involving the National Suicide Hotline. Discussion. The project begins to demonstrate that self-reported suicide prevention knowledge and skills show immediate improvements after a brief training module nested within a broader new volunteer training. This work should support efforts to develop and implement research studies on brief suicide prevention training approaches in order to determine the extent to which they change behavior longitudinally and, ultimately, reduce rates of suicide.

Suicide Prevention Across Countries and Continents: Lessons Learned

Suicide Prevention Across Countries and Continents: Lessons Learned

Suicide in England in the COVID-19 Pandemic: Early Figures from Real Time Surveillance

Background: There are concerns that the COVID-19 pandemic may lead to an increase in suicide. The coronial system in England is not suitable for close monitoring of suicide because of the frequent gap of several months before inquests are held. Methods: We used data from established systems of "real time surveillance" (RTS) of suspected suicides, in areas covering a total population of around 13 million, to examine for any increase after the first national lockdown in England. Outcomes: The average monthly number of suicides in the months before lockdown, January-March 2020, was 125·7, compared to 121·3 in April-October 2020 (-4%; 95% CI -19% to 13%, p=0·59). Incidence rate ratios did not rise significantly in individual months after lockdown began and were not raised during the 2-month lockdown period April-May 2020 or the 5-month period after the easing of lockdown, June-October 2020 (IRR: 1·00 [0·8-1·25] and 0·94 [0·81-1·08]). Comparison of the suicide rates after lockdown in 2020 for the same months in selected areas in 2019 showed no difference. Interpretation: We did not find a rise in suicide in England in the months after the first national lockdown began in 2020, despite evidence of greater distress. However, a number of caveats should be noted. These are early figures and may change. Any effect of the pandemic may vary by population group or geographical area. The use of RTS in this way is new and further development is needed before it can provide full national data. Funding: The study was carried out as part of the role of the National Confidential Inquiry into Suicide and Safety in Mental Health in supporting suicide prevention in England, funded by NHS England/NHS Improvement.Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: LA chairs the National Suicide Prevention Strategy Advisory Group (NSPSAG) at the Department of Health and Social Care in England; NK is a member of the Group, chaired the guideline development group for the 2012 National Institute for Health and Clinical Excellence (NICE) guidelines on the longer-term management of self-harm, currently chairs the guideline development group for the NICE depression in adults’ guidelines, is currently the topic advisor on the new NICE guideline on self-harm, and reports grants from the Department of Health and Social Care, National Institute of Health Research and NICE. All authors work with NHS England on the National Quality Improvement initiatives for suicide and self-harm. LA, NK, and PT report grants from the Health Quality Improvement Partnership.

Do online media adhere to the responsible suicide reporting guidelines? A cross sectional study from India.

The content and nature of media reports could influence suicide prevention measures. To evaluate contemporary online media reports' compliance with guidelines for responsible reporting of suicidal acts from Indian resources. We included English and Hindi articles for reports concerning suicide, published by local and national media sources for 30 consecutive days from the day of death of a celebrity by alleged suicide. The search was performed in Google News with predefined search queries and selection criteria. Two independent investigators did data extraction. Subsequently, each news report was assessed against guidelines for the responsible reporting of suicide by the WHO and the Press Council of India. We identified 295 articles (Hindi n = 172, English n = 123). Results showed more than 80% of the media reports deviated from at least one criterion of the recommendations. A maximum breach was seen in the news article's headlines, sensational reportage and detailed suicide methods description. Significant differences were seen in the quality of English and Hindi reporting and reporting celebrity and noncelebrity suicide. Additional items revealed were reporting suicide pacts, linking multiple suicides in a single news report, allowing user-generated threads and linking Religion and suicide. Measures are required to implement reporting recommendations in the framework of a national suicide prevention strategy.

Zero suicide implementation-effectiveness trial study protocol in outpatient behavioral health using the A-I-M suicide prevention model

BackgroundThe treatment of suicidal patients often suffers owing to a lack of integrated care and standardized approaches for identifying and reducing risk. The National Strategy for Suicide Prevention endorsed the Zero Suicide (ZS) model, a multi-component, system-wide approach to identify, engage, and treat suicidal patients. The ZS model is a framework for suicide prevention in healthcare systems with the aspirational goal of eliminating suicide in healthcare. While the approach is widely endorsed, it has yet to be evaluated in a systematic manner. This trial evaluates two ZS implementation strategies statewide in specialty mental health clinics. Methods/study designThis trial is the first large-scale implementation of the ZS model in mental health clinics using the Assess, Intervene, and Monitor for Suicide Prevention (A-I-M) clinical model. Using a hybrid effectiveness-implementation type 1 design, we are testing the effectiveness of ZS implementation in 186 mental health clinics in 95 agencies in New York State. Agencies are randomly assigned to either: “Basic Implementation” (BI; a large group didactic learning collaboratives) or “Enhanced Implementation” (EI; participatory small group learning collaboratives; enhanced consultation for site champions). Primary outcomes include suicidal behaviors, hospitalizations and Emergency Department visits; implementation outcomes include protocol adoption, protocol fidelity and barriers/facilitators to implementation. DiscussionThis project has the potential to have a significant public health impact by determining the effectiveness of the ZS model in mental health clinics, a setting where suicide attempts and suicides occur at a higher rate than any other healthcare setting. It will also provide guidance on the implementation level required to achieve uptake and sustainability of ZS.Trial registration: N/A.

Social Work Instructors’ Attitudes, Beliefs, and Practices about Teaching Suicide Content

ABSTRACT In 2012, the National Strategy for Suicide Prevention recommended more education in suicide prevention for mental health professionals. This study of social work instructors (N = 225) explored attitudes, beliefs, and feelings toward teaching suicide content in practice courses; the content covered; barriers to teaching about suicide; and desired supports. Overall, instructors were confident and perceived themselves as knowledgeable, teaching primarily assessment, crisis intervention, and safety planning. However, some instructors described teaching outdated material (e.g., “no suicide” contracts) and some best practices were sparsely covered. Recommendations are presented here, including increasing training opportunities and creating materials and guidelines to support instructors teaching this content.

Suicide, Self-Harm, & Traumatic Stress Exposure: A Trauma-Informed Approach to the Evaluation and Management of Suicide Risk

ABSTRACT Suicide and self-harm are major public health problems. Individuals who die by or attempt suicide and those who self-harm have elevated rates of traumatic stress exposure, underscoring the importance of a trauma-informed approach to suicide prevention. Rooted in the evidence on care for traumatic stress and suicide prevention, and our collective experience as clinicians and clinical researchers, this manuscript bridges these two literatures to offer clinical guidance on an evidence-based trauma-informed approach to suicide prevention. We describe our evidence-based approach to trauma-informed suicide prevention care: SAFETY-Acute (A) also known as the Family Intervention for Suicide Prevention (FISP). This approach offers a therapeutic assessment and intervention following a suicidal episode that aims to further assess safety and engage in a developmentally-informed safety planning process with the youth and parents/caregivers. In randomized controlled trials, SAFETY-A has demonstrated efficacy for improving continuity of care after an Emergency Department visit for suicidality (Objective 8.4 of the National Strategy for Suicide Prevention) and for reducing suicide attempt risk when combined with evidence-based follow-up treatment. We illustrate the approach with a case example, and offer comments based on our experience across diverse clinical settings including emergency and crisis services, outpatient clinics, and schools.

The national strategy for suicide prevention in the Netherlands: on the road to zero suicides

Abstract Background In the Netherlands, 1829 persons (11.6/100.000) ended their life by suicide in 2018. Two out of three suicides concern men, most of them in the age group of 50-55. Suicide amongst youth is rising, especially amongst youngsters between 10-25. Around 40 persons a day, predominantly young and female, are treated in Dutch hospitals after having attempted suicide. Only 40% of those who die by suicide have been in touch with healthcare professionals. These figures made the Dutch government to put in place a national strategy for suicide prevention. Methods This strategy follows the WHO's guidance and covers a range of measures in public health as well as in the health care sector. Its implementation is coordinated by “113 Suicide prevention”, the national centre of expertise on suicide prevention in the Netherlands. Results A broad package of measures is being implemented simultaneously, targeting the entire population as well as specific vulnerable groups, such as youngsters, persons with LGBT related issues and persons with mental health needs. We initiated several collective preventive measures, such as media guidelines for safe reporting, a public awareness campaign against stigma, reduction of access to deadly means or places; selective prevention initiatives, e.g. training over 3400 of gatekeepers to detect and address suicidal thoughts with desperate persons; and indicated suicide prevention strategies including screening, treatment and follow up of patients with suicidal behaviour in general practice or mental health hospitals. In this presentation the different components of the Dutch strategy for suicide prevention will be described more in detail, and experiences and first results of the different components will be addressed. Conclusions The relevance of the Dutch national strategy is related to the broad package of measures implemented simultaneously in many domains of society, but closely monitoring and evaluating the effect stays challenging.

National suicide management guidelines with family as an interv’ention and suicide mortality rates: a systematic review protocol

IntroductionSuicidal behaviour remains a major public health challenge worldwide. Several countries have developed national suicide guidelines aimed at raising awareness of and preventing deaths by suicide. One of the interventions...

Problem gambling and suicidality in England: secondary analysis of a representative cross-sectional survey

ObjectivesProblem gamblers in treatment are known to be at high risk for suicidality, but few studies have examined if this is evident in community samples. Evidence is mixed on the extent to which an association between problem gambling and suicidality may be explained by psychiatric comorbidity. We tested whether they are associated after adjustment for co-occurring mental disorders and other factors. Study designSecondary analysis of the Adult Psychiatric Morbidity Survey 2007, a cross-sectional national probability sample survey of 7403 adults living in households in England. MethodsRates of suicidality in problem gamblers and the rest of the population were compared. A series of logistic regression models assessed the impact of adjustment on the relationship between problem gambling and suicidality. ResultsPast year suicidality was reported in 19.2% of problem gamblers, compared with 4.4% in the rest of the population. Their unadjusted odds ratios (OR) of suicidality were 5.3 times higher. Odds attenuated but remained significant when depression and anxiety disorders, substance dependences, attention-deficit/hyperactivity disorder, and other factors were accounted for (adjusted OR = 2.9, 95% confidence interval = 1. 1, 8.1 P = 0.023). ConclusionsProblem gamblers are a high-risk group for suicidality. This should be recognised in individual suicide prevention plans and local and national suicide prevention strategies. While some of this relationship is explained by other factors, a significant and substantial association between problem gambling and suicidality remains.

Long Overdue: Decriminalisation of Attempted Suicide in Nigeria

Suicide has become more notorious in recent years, and is now reported regularly in the news. There is greater awareness of the challenge of suicide and attempted suicide partly as a result of increase in social media use. Attempting suicide is a criminal offence under Nigeria’s criminal laws. This law is currently enforced in several states in Nigeria. A legacy of old law from the era of British colonization, several other African countries have provisions in their criminal legislation criminalizing suicide attempts. This paper argues that this provision is retrogressive and unhelpful. It provides an overview of suicide in Nigeria, the factors that have been identified as leading to suicide and suicidal ideation and the state of the criminal law on attempted suicide in Nigeria, including the recent reforms in Lagos State. It argues that in light of current realities, better understandings of mental health, and the public health importance of preventing suicides, the provisions criminalizing attempted suicide in Nigeria should, as a matter of urgency, be repealed. It makes several recommendations relating to developing a national suicide prevention strategy and more robust approaches to addressing mental health from a legal perspective.

Suicide Prevention in the African Region.

This paper addresses national responses to suicide prevention in the African region. Eighteen countries responded, of which none had a national suicide prevention strategy in place and only three countries, namely Algeria, Congo, and Madagascar, were in the process of developing any kind of strategy, at the time of this survey. Official national statistics on suicide were available in four of the 18 AFRO countries, with two countries publishing figures on suicide attempts nationally. Training programs on suicide assessment and interventions for general practitioners or mental health professionals were very limited, available in just four countries. One country had a national center specifically dedicated to suicide research or prevention and four countries have at least one NGO dedicated to suicide prevention. Postvention bereavement support for families affected by suicide was available in three AFRO countries. In more than half of the countries, suicide is not an option to certify cause of death. Statistics on suicide and suicide prevention are poorly monitored in all the 18 AFRO countries. The present state of suicide prevention in the region will require cross-country efforts that will generate a critical mass to move suicide advocacy in establishing national prevention strategies in the region.

Suicide Prevention in the European Region.

Although the majority of the world's suicides occur in Asia, suicide and self-harm are major concerns in Europe as well. Suicide accounts for 1.4% of the total number of deaths in Europe, with rates highest among those aged over 70 and also high among those aged 45-59 years. Europe accounts for six of the top ten countries with the highest suicide rates internationally. Although rates of suicide attempts and self-harm are not consistently recorded, evidence from hospital-based studies and school-based surveys highlight their extent and scale. Numerous countries in Europe have developed national suicide prevention strategies and action plans. Some of the suicide prevention activities in Belgium, Estonia, Finland, Scotland, France, Germany, Romania, Russia, Sweden, Ukraine, and Italy are summarized. In the chapter we also highlight novel suicide prevention projects funded by the EU which have advanced our understanding of suicide risk and have developed the evidence base for what works to prevent suicide. Examples include the European Alliance Against Depression (EAAD), Saving and Empowering Young Lives in Europe (SEYLE), Suicide Prevention Through Internet and Media Based Mental Health Promotion (SUPREME), and Reduction of Suicides and Trespasses on Railway Property (RESTRAIL). Future challenges and opportunities for suicide prevention in Europe are also discussed.

Suicide and Suicide Prevention From a Global Perspective.

In this introductory chapter, we provide the background and rationale for the compilation of overviews of national suicide prevention strategies from all geographic regions globally. Currently, suicide is the second leading cause of death among young people aged 15-29 years at global level. Overall, suicide rates in low- and middle-income countries (LMIC) are lower than the rates in high-income countries (HIC) of 11.2 per 100,000 compared with 12.7 per 100,000 population, but the majority of suicide deaths worldwide occur in LMICs. However, there are ongoing challenges in relation to the accuracy of suicide figures in many countries. The rationale for the global approach to suicide prevention is linked to major strategic documents provided by the WHO, including the Global Mental Health Action Plan, 2013-2020, the WHO report Preventing Suicide: A Global Imperative, in 2014, and the United Nations Sustainable Development Goals (SDGs) for 2030, including a target of reducing premature mortality from noncommunicable diseases by one-third, with suicide mortality rate identified as an indicator for this target. In addition, a review is provided of the evidence base and best practice of suicide prevention programs.

Future Directions.

This final chapter focuses on the progress made so far in the area of suicide prevention and calls attention to considerations for future work. Recommendations for the implementation of national suicide prevention strategies are proposed, including close collaboration between countries within the same geographic region, as well as guidance from countries wherein national strategies have successfully implemented, such as the sharing of effective strategy templates. In addition, the value of accurate surveillance data in overcoming barriers, informing actions and responding to real time trends in suicide and self-harm is emphasized. The need for more systematic research into the efficacy of intervention and prevention approaches is also highlighted. Furthermore, the provision of governmental support to ensure long-term sustainability of national suicide prevention strategies is endorsed. Approaches to enhance the evaluation of the efficacy of national suicide prevention strategies and interdisciplinary partnerships and collaborations are discussed. Finally, recommended resources to assist in implementing and evaluating key components of national suicide prevention strategies are listed.

Suicide in Northern Ireland: epidemiology, risk factors, and prevention.

The rates of suicide and self-harm in Northern Ireland are high, and have increased from 143 registered suicides in 1996 to 313 in 2010 and 318 in 2015. This Review summarises the epidemiology of suicidal behaviour, as well as the evidence from a small number of studies that have identified risk factors associated with high suicide rates in Northern Ireland. These risk factors were mental illness, trauma, exposure to the conflict known as the Troubles, deprivation, relationship problems, employment difficulties, financial difficulties, being LGBT, childhood adversities, and alcohol or drug use. We highlight the key challenges and opportunities for suicide prevention, emphasising a so-called lifespan approach. More needs to be done to address the relationship between substance misuse and suicide. Future research and prevention efforts should also focus on the transgenerational effect of the conflict, youth suicide, suicide prevention in minority groups, and the criminal justice context. The provision of and access to suicide-specific psychosocial interventions need to be prioritised, more support for people in crisis is required, as well as interventions for mental illness. Protect Life 2, the national suicide prevention strategy, needs to be implemented in full. Given the legacy of conflict in Northern Ireland, all suicide prevention efforts should be trauma informed.

Age patterns of suicide with different methods for US Whites: APC modelling analysis of the 1999-2017 national data.

Suicide emerges as a threat to national health of USA with Whites being at extra risk. More information is needed regarding the increased suicide among Whites to improve national suicide prevention strategies. This study aims to characterise the age pattern of suicide among Whites by suicide methods adjusting for time period and birth cohort. Suicide mortality data by age of 15-84 years during 1999-2017 were derived from the Wide-Ranging Online Data for Epidemiological Research, prepared by US Center for Disease Control and Prevention. Mortality data for three common suicide methods, firearms, suffocation and poisoning were analysed using the age-period-cohort (APC) model. Period-cohort adjusted mortality rates by age were estimated based on results from APC modelling. Period-cohort adjusted rates indicated that the overall age pattern for males contained five phases, including three increasing phases (ages 15-20, 30-50 and 65+), connected by two declining phases (ages 20-30 and 50-65); and the age pattern for females was a parabolic with an increasing phase from 15 years of age up to 50, followed by a declining phase after age 50. Furthermore, the age pattern for different suicide methods differed substantially for males, but did not for females. Among males, suicide by firearms contained two rapid increasing phases, one during adolescence and another in older ages; suicide by suffocation showed a high plateau across an age span from 20 to 55 years; and suicide by poisoning followed a parabolic, increasing by age up to 45 before it declined. Age patterns revealed by the unadjusted crude rates were biased because of significant linear period effect and W-shaped cohort effect. This study is the first to quantify the age patterns of suicide by different methods for US Whites using period-cohort adjusted rates. Study findings provide valid evidence supporting precision interventions to reduce the extra suicide mortality among Whites by targeting specific age ranges with different suicide methods.

A population-based analysis of suicidality and its correlates: findings from the National Mental Health Survey of India, 2015–16

India accounts for 18% of the global population and 26·6% of global suicide deaths. However, robust population-based, nationally representative data on suicidality are not readily available to plan and implement suicide prevention programmes in India. We aimed to investigate the prevalence and sociodemographic differentials of suicidality using data from the National Mental Health Survey (NMHS) of India, 2015-16. Trained field data collectors from the NMHS obtained information on suicidality (during the past month) from a community sample of adults aged 18 years and older using the suicidality module of the Mini-International Neuropsychiatric Interview (version 6.0). Suicidality was categorised as low, moderate, high, and overall (representing any suicidality), and examined for sociodemographic differentials using normalised sampling weights. For each of the 12 surveyed states, we calculated the age-standardised suicidality prevalence for men and women, men-to-women ratio of weighted suicidality prevalence, ratio of suicidality to suicide deaths, and ratio of suicide attempts to suicide deaths. We used logistic regression analysis to examine the association between sociodemographic factors and overall suicidality and severity. Among 34 748 participants with complete interviews, 5·1% (95% CI 4·7-5·6) had some level of suicidality, and 0·3% (0·2-0·4) had at least one suicide attempt in the past month. The prevalence of overall suicidality was higher in women (6·0% [5·4-6·6]) than in men (4·1% [3·7-4·6]). The prevalence of overall suicidality was highest in those aged 40-49 years among women and in those aged 60 years or older among men. Compared with their counterparts, individuals with lower educational attainment, individuals residing in urban metropolitan cities, individuals who were widowed, separated, or divorced, and unemployed individuals had a higher prevalence of overall suicidality. The men-to-women ratio of overall suicidality prevalence for India was 0·68 (range 0·55-0·85). For every death by suicide in India, there were more than 200 people with suicidality and more than 15 suicide attempts. We found variations for various severities of suicidality. We found an increased risk for overall suicidality in women versus men (odds ratio [OR] 1·54 [95% CI 1·31-1·81]; p<0·0001) and in individuals residing in urban metropolitan cities versus those residing in rural areas (1·75 [1·30-2·35]; p=0·0002). Individuals belonging to the lowest income quintile (reference group with OR <1·00 and p<0·05 for other income quintiles), those with depressive disorders (28·78 [20·04-41·33]; p<0.0001) and those with alcohol use disorders (6·52 [3·83-11·10]; p<0.0001) had an increased risk for high suicidality, compared with their corresponding counterparts. A national suicide prevention strategy that is comprehensive, using multisectoral approaches, is required to address the prevailing sociodemographic and other risk factors for reducing suicidality and suicide deaths in India. This study also has implications for other low-income and middle-income countries in south Asia, where sociodemographic factors play a crucial role for suicide prevention. Ministry of Health and Family Welfare, Government of India.