Reduce Suicide Rates Research Articles

Socio-economic determinants of suicide rates in transforming China: A spatial-temporal analysis from 1990 to 2015

SummaryBackgroundChina has experienced dramatic social changes in the last three decades. This study aimed to investigate socio-economic factors related to suicide rates in China from 1990 to 2015, and examine how the impacts of these factors on suicide rates changed over time.MethodsSuicide rates in 31 provinces in mainland China between 1990 and 2015 were obtained from the Global Burden of Disease (GBD) Study 2019. Temporal-spatial modelling was applied to assess the effects of GDP per capita, urbanization, migration, employment, divorce, proportions of children and older adults on provincial overall, male and female suicide rates.FindingsThe overall suicide rate in China declined from 18·1 /100,000 in 1990 to 8·6 /100,000 in 2015, with considerable spatial variation in the magnitude of decline across provinces. The protective effects of increasing in GDP per capita, and urbanization, on provincial suicide rate were strong in 1990 (log GDP: -3·56 [95% CI: -6·15, -0·96], urbanisation: -0·07 [-0·14, -0·01]), however these effects were negligible by 2015. The association between employment and suicide rates has shifted from positive to negative over the study period, while migration remained a constant risk factor for high suicide rates (0·04 [0.00, 0·09]).InterpretationThis study highlighted the dynamic effects of economic and social factors on suicide rates in the context of transforming China. To maintain further reductions in suicide rates cannot rely simply on improving people's materialistic and economic conditions. A more holistic approach to improve overall population well-being is needed.FundingHumanities and Social Sciences Prestigious Fellowship (37000320) and the General Research Fund (17611619) at the University of Hong Kong.

Exploring multiple pathways and mediation effects of urban environmental factors for suicide prevention

Public health is threatened by air pollution and high temperature, especially in urban areas and areas impacted by climate change. Well-designed urban forms have co-benefits on promoting human health and mediating atmospheric environment-related threats (e.g., high temperature and air pollution). Previous studies overlooked these mediating effects of urban form on suicide mortality. This study used partial least squares modeling and countywide data in Taiwan to identify the crucial influences and pathways of urban environment, socioeconomic status, and diseases on suicide mortality. The model considered the impact of the characteristics of urban form (i.e., urban development intensity, land mix, and urban sprawl), urban industrial status (i.e., industrial level), urban greening (i.e., green coverage), disease (i.e., important diseases morbidity of human immunodeficiency virus [HIV], cerebrovascular disease [CVD], chronic liver disease and cirrhosis [CLDC], nephritis, nephrotic syndrome and nephrosis [NNSN], malignant tumor [MT]), socioeconomic status (i.e., income level and aging population rate), and the atmospheric environment (i.e., air pollution and high temperature) on suicide mortality. Optimizing land mix and minimizing urban development intensity and urban sprawl have been found to reduce suicide mortality. The mediating effect of urban form on suicide mortality originated from air pollution and high temperature, and mediating air pollution was greater than high temperature. Furthermore, industrial level, important diseases (HIV, CVD, CLDC, NNSN, and MT) morbidity, an aging population rate, air pollution, and high temperature were associated with an increase in suicide mortality, whereas green coverage and income level were associated with a reduction in suicide rates. The findings demonstrate that appropriate urban policy and urban planning may lower suicide mortality, be useful strategies for suicide prevention, and be a foundation for building a healthy city. Moreover, this study provides clarity on the complex relationship of suicide and the urban environment while identifying crucial factors.

Suicide in the construction industry: literature review

Urgent needs to tackle the pervasiveness of suicide in the construction industry due to economic and social consequences sparked burst in literature to address the root causes and intervention for suicide. To comprehend the current state of art of suicide in the construction industry, systematic review becomes the viable option. Despite this, there is scanty study on systematic review of suicide in the construction industry. Therefore, this paper aims to systematically review 28 extant studies on suicide in the construction industry from 1992 to 2021 (years inclusive) to reveal the current state of art in the subject area. The study deduced that previous studies focused on risk factors for suicide, economic cost of suicide and suicide interventions in the construction industry. Theoretically, the findings contribute to the body of literature by revealing the limitation in the identified risk factors for suicide, economic cost of suicide and suicide intervention to unpack future studies on suicide risk factors, optimum investment in suicide and theoretical model on relationships between suicide risk, suicide interventions and suicide in the construction industry. To the practitioners, the identified risk factors can be used to develop psychosocial risk management for suicide, economic cost to determine the optimum financial investment for suicide prevention and suicide interventions to reduce suicide rate among construction workers.

Neuropsychiatric Approaches for Human Suicide Prediction and Management

Human suicide accounts for 2% Human mortality worldwide. Some widely accepted medical knowledge suggests that suicide events or episodes are strongly associated with neuropsychiatric events and changes. We previously accumulate data and evidence that neuropsychiatric study and interference may help us to reduce suicide rates and mortality. Given the useful evidence and therapy in the clinic, cutting off unnecessary suicide-induced genes or molecules will ultimately reduce suicide-induced mortality in statistically significant manner. This article discusses how the genetic, epigenetic and molecular phenotypes can be manipulated in the lab animals and a framework of neuropsychiatric changes and interferences in patients. Possible drug targets and treatments are also discussed.

Association of the type of counselor with suicidal ideation and suicide attempts: a survey of South Korean adolescents

BackgroundCounseling for adolescents who consider or attempt suicide may help reduce suicide rates. However, the impact of the type of counselor (e.g., father, mother, sibling, friend, teacher, other) on suicidal ideation/suicide attempts remains unclear. Therefore, we examined this association in Korean adolescents.MethodsUsing data from the 2015 Korea Youth Risk Behavior Web-based Survey of 65,485 adolescents, we examined risk factors for suicidal ideation/suicide attempts according to sex using a multiple logistic regression analysis. In a subgroup analysis, we investigated the associations between counselor type and suicidal ideation/suicide attempts stratified by the cause of stress for both sexes.ResultsMale participants were less likely to consider suicide when counseled by their mother (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.70–0.90) or friend (OR 0.89; 95% CI 0.80–0.99) and to attempt suicide when counseled by a friend (OR 0.74; 95% CI 0.60–0.92) than were those who did not receive any counseling. Female participants were less likely to attempt suicide when counseled by their mother (OR 0.66; 95% CI 0.53–0.82) or friends (OR 0.70; 95% CI 0.58–0.83) than when not counseled. Furthermore, adolescents with achievement/career choice-related and family problems were at a lower risk of suicide ideation/suicide attempts when counseled by their mother or friend than when they received no counseling.ConclusionsSuicidal ideation/suicide attempts showed different associations for both sexes in accordance with the type of counselor. Even if counseling by specialists for issues such as achievement/career choice-related or family matters is needed, the risk of suicide could be reduced through counseling by the people around them. Therefore, adolescents should form mutually supportive relationships through active communication with surrounding people.

Hospital-Based Case Management for Suicide High-Risk Group Using Delphi Survey.

Objective As of 2019, suicide is serious problem in Korea, with the highest suicide rate among OECD countries. To reduce suicide rates Emergency Department Based Post-Suicide Attempt Case Management carried out with government funding in South Korea, but it is insufficient to address the issue. Aim of this study is to prevent suicide attempts through continuous provision of mental health services even after discharge from acute care. Methods We selected 15 mental health specialists who are multidisciplinary experts in Suicide Prevention. Two-round Delphi survey was conducted on them to reach an agreement for hospital-based case management. Results The first Delphi survey consisted of 8 areas and 39 questions. Among them, 30 questions draw agreement above the reference value. The second Delphi survey, consisted of 37 questions, resulted in 32 above-standard questions. Conclusion Consensus was reached in most category of the Hospital Based Case Management for Suicide High-Risk Group. Core of the developed plan was to provide services to patients who visited the hospital, pursue the stability and universalization of services through a medical insurance fee system. In the future, hospital-based case management service will be implemented as a new model contributing to the reduction of suicide rates in Korea.

Time Trends and Predictions of Suicide Mortality for People Aged 70 Years and Over From 1990 to 2030 Based on the Global Burden of Disease Study 2017.

Background: High suicide rate in the elderly is an important global public health problem but has not received the attention it deserves. This study aimed to examine time trends of suicide mortality for people aged 70 years and over by sex, age, and location from 1990 to 2017, and to provide predictions up to 2030.Methods: Using data from the Global Burden of Disease study 2017, we presented elderly suicide mortality changes and compared the patterns for the elderly with that for all ages. We estimated associations between socio-demographic index (SDI) and suicide mortality rates using a restricted cubic spline smoother, and predicted suicide mortality rates up to 2030.Results: In 2017, 118,813 people aged 70 years and over died from suicide, indicating a mortality rate of 27.5 per 100,000, with the highest rates in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, and Central Sub-Saharan Africa, and for countries and territories, the highest were in South Korea, Zimbabwe, Lesotho, Mozambique, and Senegal. Between 1990 and 2017, suicide mortality rate for the elderly aged 70 years and over decreased globally (percentage change −29.1%), and the largest decreases occurred in East Asia, Southern Latin America, and Western Europe. Nationally, the largest decrease was found in Chile, followed by Czech Republic, Hungary, Turkey, and Philippines. For most countries, the elderly mortality rate was higher than the age-standardized rate, with the largest percentage differences in China and countries in Sub-Saharan Africa. The elderly suicide mortality rate decreased as SDI increased, except for a slight rebound at mid to high SDI. According to projections, 10 out of 195 countries were expected to meet the SDGs indicator of a third reduction by 2030.Conclusions: Variability in suicide mortality rates for the elderly aged 70 years and over by sex, age, region, country, and SDI can guide preventive policies, but causes of the variability need further study. Comprehensive strategies should be adopted to reduce suicide rates and close the gap to the 2030 SDGs.

Demographic and epidemiological decomposition analysis of global changes in suicide rates and numbers over the period 1990–2019

BackgroundSuicide presents an ongoing public health challenge internationally. Nearly 800 000 people around the world lose their life to suicide every year, and many more attempt suicide.MethodsA decomposition analysis was...

Gatekeeper Training and Minimum Standards of Competency.

Gatekeeper training (GKT) is one of the most widely used suicide prevention strategies. It involves training people who are not necessarily clinicians to be able to identify people experiencing suicidality and refer them to appropriate services. While there is a dearth of research that supports the causal link between GKT and reduced suicide rates, this is likely the result of a variety of factors including training design, definitions of "gatekeepers," differing populations in which the gatekeeper (GK) operates, and other variables that may influence suicide rates. Despite this, research suggests that GKT improves people's knowledge, skills, and confidence in helping individuals who experience suicidal ideation and enhances positive beliefs about the efficacy of suicide prevention. However, there is no consensus on GK competencies to allow differences in effectiveness between various training programs to be measured, that is, knowledge, skills and abilities, attitudes, and self-efficacy attributes expected of a person resulting from the training. This paper discusses challenges in developing GK competencies. It uses developments in suicide prevention competencies for clinicians, vocational education, and training sector competencies, as well as empirical work in GKT, to propose minimum GK competencies that may be examined for further research and evaluation of programs.

일개지역 노인의 일상생활수행능력과 우울, 사회 참여가 자살생각에 미치는 영향

Objectives: This study aimed to examine the effect of Activities Daily Living(ADL)(physical health), depression(mental health), social participation(social health) on suicidal ideation among community dwelling elderly. Methods: Samples were obtained from 184 people aged over 65 years old in one county of Kyungsangbukdo. The survey samples were divided into the presence and absence group of the suicidal ideation. Data were analyzed with x2 test, t-test and logistic regression analysis. Results: First, suicidal ideation were significantly different by religion. Secondly, after adjusting for socio-economic variables, logistic regression analysis showed that only depression was associated with higher odds of suicidal ideation Conclusions: It was suggested to develop customized depression and suicide prevention program were required to reduce suicide rate of the elderly.

Suicide rates for young Aboriginal and Torres Strait Islander people: the influence of community level cultural connectedness.

To examine associations between community cultural connectedness indicators and suicide mortality rates for young Aboriginal and Torres Strait Islander people. Retrospective mortality study. Suicide deaths of people aged 10-19 years recorded by the Queensland Suicide Register, 2001-2015. Age-standardised suicide death rates, by Indigenous status, sex, and age group; age-standardised suicide death rates for young First Nations people by area level remoteness and Index of Relative Socioeconomic Advantage and Disadvantage, and by cultural connectedness indicators (at statistical area level 2): cultural social capital index score, community Indigenous language use, and reported discrimination. The age-specific suicide rate was 21.1 deaths per 100 000 persons/year for First Nations young people and 5.0 deaths per 100000 persons/year for non-Indigenous young people (rate ratio [RR], 4.3; 95% CI, 3.5-5.1). The rate for Aboriginal and Torres Strait Islander young people was higher in areas with low levels of cultural social capital (greater participation of community members in cultural events, ceremonies, organisations, and community activities) than in areas classified as having high levels (RR, 1.8; 95% CI, 1.2-2.7), and also in communities with high levels of reported discrimination (RR, 2.7; 95% CI, 1.7-4.3). Associations with proportions of Indigenous language speakers and area level socio-economic resource levels were not statistically significant. We found that suicide mortality rates for Aboriginal and Torres Strait Islander young people in Queensland were influenced by community level culturally specific risk and protective factors. Our findings suggest that strategies for increasing community cultural connectedness at the community level and reducing institutional and personal discrimination could reduce suicide rates.

Association Between Medicaid Expansion and Suicide Mortality Among Nonelderly US Adults.

In 2014, the Affordable Care Act gave states the option to expand Medicaid coverage to nonelderly adults (persons aged 18-64 years) with incomes up to 138% of the federal poverty level. To our knowledge, the association of Medicaid expansion with suicide, a leading cause of death in the United States, has not been examined. We used 2005-2017 data from the National Violent Death Reporting System to analyze suicide mortality in 8 Medicaid expansion states and 7 nonexpansion states. Using a difference-in-differences approach, we examined the association between Medicaid expansion and the rate of suicide death (number of deaths per 100,000 population) among nonelderly adults. After adjustment for state-level confounders, Medicaid expansion states had 1.2 fewer suicide deaths (β = -1.2, 95% confidence interval: -2.5, 0.1) per 100,000 population per year during the postexpansion period than would have been expected if they had followed the same trend in suicide rates as nonexpansion states. Medicaid expansion was associated with reductions in suicide rates among women, men, persons aged 30-44 years, non-Hispanic White individuals, and persons without a college degree. Medicaid expansion was not associated with a change in suicide rates among persons aged 18-29 or 45-64 years or among non-White or Hispanic individuals. Overall, Medicaid expansion was associated with reductions in rates of suicide death among nonelderly adults. Further research on inequities in Medicaid expansion benefits is needed.

The effect of state gun laws on youth suicide by firearm: 1981-2017.

Many studies have found that state gun laws that regulate the purchase and possession of firearms can lead to a reduction in suicide rates. Yet, the literature has primarily focused on the effects of state gun laws on adult suicides, despite the fact that some gun laws are specifically tailored to restrict the purchase and possession of firearms by youths. In this study, we estimate the effect of two such laws-Child Access Prevention (CAP) laws and minimum age laws-on youth suicide by firearm rates. Our sample consists of state-level panel data for 41 states observed over the years 1981-2017. Based on a series of negative binomial regression analyses, we confirm previous research by finding that CAP laws are associated with a decrease in youth suicides by firearm, especially among males. However, we show that this effect is limited to states that have adopted relatively strict CAP laws. We also find that minimum age laws serve to reduce the youth suicide rate, but once again this effect is largely concentrated among males. Finally, we investigate the possibility that these effects were countered to some degree by "means substitution"-the substitution of firearms with other methods of suicide. Similar to other studies that have examined this question, we find no effect of youth-targeted gun laws on nonfirearm suicide deaths. Despite the noteworthy increase in youth suicide rates over the last decade, our results suggest that state laws which restrict firearm access to young people continue to represent a potentially effective strategy for suicide reduction.

Outcomes of a regional suicide prevention systems intervention study: Suicide prevention by monitoring and collaborative care (SUPREMOCOL) in noord-brabant in the netherlands

IntroductionSince 2007, suicide rates increased in the Netherlands and the province of Noord-Brabant ranked second nationally with a 64% increase. 60% of people who died by suicide did not receive treatment at the time of their death. Gap analysis showed 1) lack of expertise to explore suicide risk in health care or community settings where persons at risk presented; 2) lack of swift access to specialist care addressing suicidality; 3) lack of oversight of the care process and 4) lack of follow up.ObjectivesWe developed a regional suicide prevention systems intervention with chain partners at community, general health and mental health care level to address these gaps in Noord-Brabant, aiming at a 20% decrease in the number of suicides.MethodsThe project started October 2016 and lasted 4 years. The intervention has four pillars: 1) Online decision aid for health care professionals to assess suicidal risk and to communicate with chain partners; 2) swift access to care; 3) facilitation of care through the care chain by a dedicated nurse; and 4) 12 months follow up monitoring if the patient still receives appropriate care. We examined the effect of SUPREMOCOL on suicides in a pre-post design.ResultsDuring the implementation year of the intervention, suicides in Noord-Brabant dropped 17% whereas nationally they dropped 5%, and this effect was sustained after one year.ConclusionsThis suicide prevention systems intervention is effective in reducing suicide rates. Long-term follow-up and implementation is warranted.DisclosureNo significant relationships.

Suicide-related Twitter Content in Response to a National Mental Health Awareness Campaign and the Association between the Campaign and Suicide Rates in Ontario.

Mental health awareness (MHA) campaigns have been shown to be successful in improving mental health literacy, decreasing stigma, and generating public discussion. However, there is a dearth of evidence regarding the effects of these campaigns on behavioral outcomes such as suicides. Therefore, the objective of this article is to characterize the association between the event and suicide in Canada's most populous province and the content of suicide-related tweets referencing a Canadian MHA campaign (Bell Let's Talk Day [BLTD]). Suicide counts during the week of BTLD were compared to a control window (2011 to 2016) to test for associations between the BLTD event and suicide. Suicide tweets geolocated to Ontario, posted in 2016 with the BLTD hashtag were coded for specific putatively harmful and protective content. There was no associated change in suicide counts. Tweets (n = 3,763) mainly included content related to general comments about suicide death (68%) and suicide being a problem (42.8%) with little putatively helpful content such as stories of resilience (0.6%) and messages of hope (2.2%). In Ontario, this national mental health media campaign was associated with a high volume of suicide-related tweets but not necessarily including content expected to diminish suicide rates. Campaigns like BLTD should strongly consider greater attention to suicide-related messaging that promotes help-seeking and resilience. This may help to further decrease stigmatization, and potentially, reduce suicide rates.

Suicide rates by occupation in Korea, 1993-2017: the impacts of financial crisis and suicide policy

This study compared the suicide rates among different groups of occupations in Korea and their changes from 1993 through 2017. The suicide rate tended to be low in the high skill occupations except the manager group. The suicide rates showed increases around the financial crises of 1997 and 2008 in most occupations, and the sharpest increase was observed in the managers. The suicide rate in the manager group, which was the lowest among all occupation groups until the mid 2000s, showed the sharpest increase and became the highest since 2012 among all occupation groups. The sustained reduction in suicide rates among the skilled agricultural, forestry and fishery workers in Korea, following the implementation of paraquat control since 2005, shows that means restriction is an effective and essential way for reducing suicides. While more efforts should be put into means restriction, policy makers should focus on changing public perceptions of suicide in order that it would not be accepted as a possible solution for the difficulties in life.

Can Government Responses to Unemployment Reduce the Impact of Unemployment on Suicide?

Background: Unemployment is a well-documented risk factor for suicide. Findings from a number of studies suggest that government policy plays a crucial role in mediating the unemployment-suicide relationship. Aims: Our review was designed to assess whether government policies aimed at managing unemployment can moderate the impact of unemployment on suicide and self-harm. Method: A systematic search of the Medline, ProQuest, Scopus, and Web of Science databases was conducted. All original, English-language, peer-reviewed studies examining the impact of unemployment policy on rates of suicide or self-harm were eligible for inclusion. Results: Six unique studies were identified, each using an ecological design and suicide deaths as the outcome. Three of five studies looking at unemployment benefits found a negative association with suicide rates. Studies examining the impact of active unemployment policy and employment protection legislation found evidence of beneficial effects. The effects of the policies were small and had particular benefit in reducing suicide rates among men. Limitations: The ecological designs used may limit conclusions around causality. It is unclear whether the findings generalize to those in lower- and middle-income countries. Conclusion: The findings suggest that unemployment policies can mitigate the relationship between unemployment and suicide, particularly among men.

­­The Impact of a National Cash Transfer Programme on Reducing Suicide: A Study Using the 100 Million Brazilian Cohort

Background: Socio-economic factors have been consistently associated with suicide, and economic recessions are linked to rising suicide rates. This study investigates the effect of the world`s largest conditional cash transfer (CCT) programme on suicide rates in a cohort of half the Brazilian population. Methods: We used data from the 100 Million Brazilian Cohort, covering a 12-year period (2004 to 2015). It comprises socio-economic and demographic information on 114,008,317 individuals, linked to the “Bolsa Família” programme (BFP) payroll database, and nationwide death registration data. We fitted Poisson models to estimate the incidence rate ratios for suicide, associated with exposure to the BFP and Propensity Score (PS) to group BFP beneficiaries and non-beneficiaries. We estimated the PS through multiple logistic regression using baseline socio-demographic and economic characteristics and year of registration, and ran Kernel matching analysis and several sensitivity tests. Results: In the main analysis, 33,281 suicide cases occurred among the 69,707,312 individuals followed for 305,229,883 person-years at risk. Suicide rates among beneficiaries and non-beneficiaries were 5.5 (95%CI=5.44, 5.61) and 11.1 (95%CI=10.41, 11.81) in the matched cohort and 5.4 (95%CI=5.32, 5.47) and 10.7 (95%CI=10.51, 10.87) per 100,000 individuals, in the original cohorts. BFP beneficiaries had a 61% lower suicide rate than non-beneficiaries (IRR=0.39, 95%CI=0.37,0.41) in the main analysis and similar results in all sensitivity analyses. This effect was higher among women (IRR=0.35, 95%IC=0.31,0.39), and younger individuals (IRR=0.40, 95%IC=0.37,0.44). Interpretation: CCT programs play an important role in poverty reduction and well-being improvement for beneficiaries. We have also demonstrated that it contributes towards reduced suicide rates. Targeting social determinants, using cash transfer programmes, could be important tools to limit suicide, predicted to rise in the aftermath of the economic recession, consequent to the Covid-19 pandemic.Funding Statement: The authors received no direct financial support for this article. During the study DBM held a research associate scholarship from Wellcome Trust (202912/Z/16/Z) and CIDACS has received support from the Department of Science and Technology, from the Brazilian Ministry of Health; National Research Council (CNPq), Brazil; Bill and Melinda Gates Foundation (CHAMADA MCTI/CNPq/MS/SCTIE/Decit/Fundação Bill e Melinda Gates N o 47/2014); Health Surveillance Secretariat, Ministry of Health, Brazil; Fundação de Apoio a Pesquisa do Estado da Bahia (FAPESB); Financiadora de Estudos e Projetos (FINEP); Secretaria de Ciência e Tecnologia do Estado da Bahia (SECTI), and Wellcome Trust.Declaration of Interests: All authors have no competing interests.Ethics Approval Statement: This study was approved by the two research ethics committees of the: (i) Federal University of Bahia (application number: 1023107) and (ii) London School of Hygiene & Tropical Medicine (application number: 11581).

Suicide Screening and Surveillance of Students, Discrimination, and Privacy: The Garrett Lee Smith Memorial Act

The Garrett Lee Smith Memorial Act (GLS) was first enacted in 2004 for the purposes of early screening, intervention, and prevention of suicide in students 10 to 24 years of age, and to hire more college counselors. More than 16 years later, GLS suicide prevention programs have not been found to be effective in reducing suicide rates, while their harms have not been considered. This Article reviews the state of the evidence on school suicide prevention and explores the suicide surveillance of the GLS, its systems of peer-to-peer monitoring and reporting of marginalized students “at risk”—students with disabilities, racial/ethnic, sexual, and religious minorities, victims of bullying, students with homelessness or foster care records, and other suicide risk factors. It explores the GLS public health approach to address the burdens of suicidal students, isolate suicide risks, and avoid suicide contagion. It also describes possible harms of the GLS suicide surveillance approach: stigmatization; violated privacy; estrangement from peers, parents, therapists and other social supports; police involvement and warrantless searches; potential exacerbation of suicidality; and restricted civil rights in non-school settings such as employment and involuntary commitment proceedings. It then compares the threats imposed by school surveillance for violence and suicide and suggests that paternalistic justifications might account for the relative lack of concerns raised so far regarding the latter. The Article then briefly considers the functions of participating in suicide surveillance for teachers and staff, and concludes with recommendations to repeal the GLS.

Factors that sustain Indigenous youth mentoring programs: a qualitative systematic review protocol.

This qualitative systematic review aims to identify the barriers and enablers to delivering and sustaining Indigenous youth mentoring programs for improving mental health and reducing suicide rates. The United Nations has called for global action to address Indigenous youth suicide and suicidal behavior. Indigenous youth mentoring programs aimed at improving mental health and reducing suicide rates have been conducted at smaller scales at other sites. Mentoring is culturally appropriate as it empowers communities and aligns with the principles of community, teaching and learning, kinship, and holistic health. There is a gap in the understanding of what the barriers and enablers of mentoring are in addressing Indigenous youth mental health and, ultimately, Indigenous youth suicide. This review will consider studies that include mentoring programs specifically targeted at Indigenous youth mental health and well-being that are based within a community or organization setting. Databases to be searched include CINAHL, PubMed, PsycINFO, Scopus, and Embase, as well as grey literature within Trove, OpenGrey, Indigenous HealthInfoNet, and Informit Indigenous Collection. The search will be limited to articles written in English and published from 2007 to the present. Titles and abstracts will be screened by two independent reviewers; full-text studies will be retrieved and assessed against the inclusion criteria. Results will be recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. Where possible, qualitative research findings will be pooled. Where textual pooling is not possible, the findings will be presented in narrative form.