Suicide Literacy Research Articles

Levels and Predictors of Suicide Literacy and Suicide Stigma in Spanish-Speaking Individuals.

One of the obstacles to seeking help for suicide is its social stigma. The literature suggests that suicide knowledge could impact this stigma. The present study aims to examine levels and predictors of suicide stigma and suicide literacy among Spanish-speaking individuals from Spain and Latin America. A total of 678 adults completed an online survey conducted from December 2021 to May 2022. The survey assessed sociodemographic and clinical variables, including the Literacy of Suicide Scale (LOSS-SF) and Stigma of Suicide Scale (SOSS-SF). Results showed the presence of stigmatization and a moderate level of suicide literacy. Latin Americans presented significantly more stigmatizing attitudes and lower levels of suicide literacy than Spaniards. Older age and stronger religious/spiritual beliefs were correlated with lower suicide literacy. Suicide stigma was regressed on lower suicide literacy, gender (men), stronger religious/spiritual beliefs, and lacking knowledge about how to find help. Furthermore, the region was significantly associated with the suicide glorification subscale, reporting Latin Americans' greater glorification. By examining these factors, we aim to foster a deeper understanding of the attitudes and beliefs toward suicide. This understanding is crucial, as it may inform the development of effective interventions and prevention strategies that are culturally sensitive and tailored to diverse populations.

Patterns and predictors of help-seeking intentions for suicidal ideation compared to other health conditions among rural Chinese adults

Psychological help-seeking for suicidal ideation is a critical aspect of effective suicide prevention. Past research has documented low help-seeking amongst rural residents in China. This study investigates the patterns and predictors of help-seeking intentions for suicidal ideation versus mental (depression) and physical (heart disease) health conditions among Chinese rural residents using General Help-Seeking Questionnaire Vignette version. A total of 143 rural participants from sixteen villages in Hubei province of China completed the survey via home-visiting interviews. Results revealed a general trend that the help-seeking intentions decreased as the helping sources shifted from close others (spouses, family, etc.) to professional helpers and online sources. Additionally, rural residents with higher educational levels, high self-efficacy, and more severe suicide ideations were more willing to seek help; and suicide literacy was found to be negatively associated with help-seeking intentions. The implications of the research findings are discussed.

“Validation of three scales for enhanced suicide prevention in Spanish-speaking populations: Suicidal ideation, stigma, and literacy”

BackgroundEscalating suicide rates in Spain and Latin America underscore the critical need for accurate assessment and prevention tools tailored to these populations. This study aimed to culturally adapt and validate three essential scales: the Suicidal Ideation Attributes Scale (SIDAS), the Suicide Stigma Scale - Short Form (SOSS-SF), and the Suicide Literacy Scale - Short Form (LOSS-SF). MethodA total of 678 participants (including 150 with suicidal ideation) completed an online survey. The scales underwent rigorous back-translation and adaptation by native speakers from Spain and Latin America. SIDAS and SOSS-SF were validated using Confirmatory Factor Analysis (CFA), with criteria including fit indices (e.g., RMSEA, CFI). LOSS-SF underwent validation through Item Response Theory (IRT). Additionally, gender invariance was assessed across all scales. ResultsCFA confirmed the original factor structures of SIDAS and SOSS-SF, demonstrating good fit indices and internal consistency. The analysis of LOSS-SF required excluding two items, resulting in a final Spanish version with 10 items and an unifactorial structure. Gender invariance was established across all scales. ConclusionsThe culturally adapted and validated scales in this study demonstrate robust reliability and validity for assessing suicidal ideation, suicide stigma, and suicide literacy among Spanish-speaking populations. These validated tools have the potential to enhance clinical assessment, inform personalized interventions, monitor public health initiatives, educate communities about suicide, and advance research in suicide prevention and treatment.

Changes in suicide literacy and intentions to ask about suicide: “Community Linker” training for those supporting Aboriginal people

ObjectiveGatekeeper training programs are widely used with promising results for suicide prevention. However, studies have found that when delivered to Indigenous communities, outcomes can be variable or ineffective. This study is a feasibility trial of a gatekeeper program based on the standardised ‘Question, Persuade and Refer’ (QPR) approach, which was adapted to the cultural needs of local Aboriginal communities in the Shoalhaven region of New South Wales, Australia. The study aims to identify whether 1) knowledge of suicide and intentions to help increase over the course of completing the gatekeeper program; 2) participants of different educational backgrounds have similar outcomes in suicide literacy and intentions to help; and 3) Aboriginal people and non-Aboriginal people have similar outcomes. MethodsOne hundred individuals participated in the research, of which 50% identified as an Aboriginal person. Pre- and post-training questionnaires assessed whether participants experienced an increase in suicide literacy and intentions to support others at risk of suicide. ResultsAlthough pre-test scores for suicide literacy and intentions to help were high, these increased significantly from pre- to post-test. Those with no prior gatekeeper training showed larger changes in both suicide literacy and intentions to ask about suicide compared to those with prior training. ConclusionOverall, this study highlights that delivery of culturally adapted gatekeeper training is associated with improved suicide literacy and intentions to ask about suicide amongst trainees.

Pathways to suicide for children and youth in Guyana: A life charts analysis

Background: Suicide is the third leading cause of death among youth aged 15 to 29 years old globally. Guyana has the highest rate of youth suicide in the world, yet only limited research exists. Aim: The aim of this study is to identify key features of the suicide pathway for Guyanese children and youth and to distinguish meaningful subgroups. Method: The psychological autopsy (PA) method was used to generate life charts for 15 Guyanese children and youth (10–29 years) who died by suicide. Nineteen close contacts of these individuals were interviewed about the life events of the decedent between 6 months and 5 years after their death. Semi-structured interviews lasting 30 to 150 min took place between November 2021 and January 2022. The interview data were converted into life charts and these were reviewed to uncover meaningful subgroups of suicide pathways. Results: Three groups with distinct suicide pathways were identified: hard life (46%), mental illness (20%) and interpersonal stress (20%). There were also two male youths for whom the suicidal antecedents and pathways were unclear. Interpersonal stress, alcohol, exposure to suicide and family history of suicide were common factors identified across groups. Conclusions: The findings emphasise the role of both acute and protracted interpersonal stress for child and youth suicide in Guyana. The structure and dynamics of Indo-Guyanese families are discussed. Interventions recommended include enhancing child and youth community engagement, improving mental health and suicide literacy, alcohol restriction, increasing access to support services, and reducing stigma.

Utilization of Psychosocial Support for Young Adults with Suicidal Thoughts and Behaviors

The study explores the utilization of psychosocial support by young adults facing suicidal ideation or impulses, considering a comprehensive spectrum of psychosocial services. The study sheds light on help utilization and gaps in service use among different groups. The data is derived from the baseline assessment of the research project "Outcome Evaluation [U25]". The sample includes 888 young adults who reported suicidal thoughts and behaviors. Among the participants, 55% accessed at least one psychosocial service. Medical/psychotherapy services were the most utilized (54%), followed by professional counseling (34%) and non-professional self-help services (22%). Gender differences were observed, with males using help less frequently than females and individuals with diverse gender identities. Participants in relationships were less likely to seek help than singles. A migrant background showed no consistent impact on service utilization. Psychological distress and suicide literacy were associated with increased service utilization. Regression analysis revealed that gender and relationship status remained predictors of service utilization even when considering mental distress, suicidal thoughts and behaviors, and suicide literacy.

Myths about suicide - validating the Hungarian version of the Literacy of Suicide Scale (H-LOSS) on a community sample

BackgroundSuicide was exceptionally high in Hungary in the last century. According to Eurostat, Hungary ranks second in the EU in death by suicide and was among the few countries where the suicidal tendencies increased in 2020. Primary tasks of suicide prevention programs are to develop suicide literacy and dispel myths and misconceptions about suicide. Therefore, the goal of our research was the Hungarian validation of the 26-item Literacy of Suicide Scale (LOSS). Methods: 749 people (382 female (51.0%), 364 male (48.6%), 3 identify as non-binary or other (0.4%); 4 identifying as transgender (0.5%)) participated in our online cross-sectional survey with a mean age of 32.4 years (SD = 14.5 years). The H-LOSS questionnaire was adapted using the 2PL (two-parameter logistic) model with WLSE (weighted least squares) estimation in item response theory method, similarly to the original English version.ResultsScale unidimensionality was confirmed. Model fit indices and internal reliability indicators were acceptable. Item infit and outfit values were adequate, item discrimination values were within range, but one item had extremely high and three items had extremely low item difficulty parameters. Few items had differential item functioning by age, gender and own suidice attempt.ConclusionsThe H-LOSS scale deemed to be appropriate for assessing suicide literacy in Hungarian speaking samples.

Literacy and Attitude Toward Suicide Among Doctors and Nurses: A Cross-Sectional Comparative Study.

Introduction Globally, suicide remains a major public health problem and is the second most common cause of death in the 15-45 years age group. Awareness about suicide and the attitude of healthcare professionals regarding suicide are crucial factors determining the care for suicidal behaviors. The present study aimed to compare suicide literacy and attitude towardsuicide between doctors and nurses and to explore the association between suicide literacy and attitude toward suicide. Methods A cross-sectional comparison study was conducted between doctors and nurses in a tertiary healthcare center in southern India. The demographic characteristics and work and suicide care experience were recorded using a semi-structured proforma. Literacy of Suicide Scale - Short Form (LOSS-SF) and Attitude Toward Suicide Questionnaire (ATTS) were used to assess the awareness about suicidal behaviors and attitudes towardsuicide, respectively. Appropriate statistical tests were used to compare the outcome measures between doctors and nurses with the statistical significance set at p ≤ 0.05. Results A total of 600 healthcare professionals (doctors (n=300) and nurses (n=300)) were included. The doctors were older, had longer work experience, and demonstrated better suicide literacy, yet harbored more negative attitudes towardsuicide than nurses. Among doctors, increasing levels of suicide literacy were negatively correlated with positive attitudes towardsuicide. Among nurses, increasing age was negatively correlated with healthy attitudes towardsuicide. Conclusion Doctors had better awareness of suicidal behaviors yet displayed negative attitudes towardpeople with suicidal behaviors. Despite having less suicide awareness, nurses exhibited positive attitudes towardsuicide. Suicide literacy and attitudes towardsuicide can have complex relationships mediated by multiple factors.

Suicide Literacy and Attitudes Toward Seeking Psychological Help among Medical Residents.

This study investigates suicide literacy, help-seeking attitudes, and related factors among medical residents. The study utilized a cross-sectional design and included all medical residents in Kerman University of Medical Sciences in 2023‒2024. We obtained demographic information, psychiatric history, and administered questionnaires about literacy of suicide (LOSS) and the Attitudes Toward Seeking Professional Psychological Help (ATSPPH-SF). A total of 157 residents with a mean age of 28.97±2.55 years participated. The prevalence of any psychiatric history was 17.83% (95% CI: 12.1‒23.56). Notably, more educated males displayed higher suicidal literacy (95% CI: 0.231‒0.567, P=0.032), while there was no significant difference in help-seeking attitudes between genders (P=0.755). Surgical residents scored lower than non-surgical specialties like pediatrics (mean difference=2.63, 95% CI: 0.23-5.03, P=0.023, effect size d=0.589). Older age positively correlated with help-seeking attitudes (r=0.158, P=0.049). Additionally, marital status, residency level, history of psychiatric illnesses and their types, previous use of psychiatric medications, and history of self-harm or suicide had no significant impact on suicide literacy scores or attitude toward help-seeking. A moderate association (r=0.367) was found between the suicide literacy and help-seeking attitude questionnaire scores. Despite relatively high suicide literacy, medical residents displayed average help-seeking attitudes, positioning them as a high-risk group. Urgent interventions are needed to enhance awareness of the importance of psychological support and to reduce stress and work pressure, indirectly mitigating the risk of suicide in this vulnerable population.

Effectiveness of a school-based Life Gatekeeper Training Program on suicide prevention in China: protocol for a randomized controlled trial

BackgroundWith suicide as a leading cause of death, the issue of children and adolescent suicide risks is in the spotlight today. To empower teachers in primary and secondary schools to serve as gatekeepers and to ensure the safety of children and adolescents, the systematically tailored and localized Life Gatekeeper suicide prevention program was designed for Chinese schools.ObjectiveWith the ultimate goal of preventing child and adolescent suicide, we aim to outline a research protocol for examining outcomes of the recently created standardized school-based Life Gatekeeper program in reducing teachers’ stigma, increasing their knowledge, willingness to intervene, and perceived competence.MethodsParticipants will be recruited from eligible primary and secondary schools. Cluster sampling will be used to randomly assign each school to either the intervention group or the control group. The primary outcomes are stigma against suicide, suicide literacy, perceived competence, and willingness to intervene with suicidal individuals, which will be measured using the Stigma of Suicide Scale, the Literacy of Suicide Scale, and the Willingness to Intervene Against Suicide Questionnaire, respectively. Measurements will be taken at four time points, including pre-intervention, immediately after the intervention, 6-month follow-up, and 1-year follow-up.ConclusionsThe current study features innovative implementation in the real world, by using a randomized controlled trial design to examine the effectiveness of a school-based gatekeeper program among primary and secondary school teachers, following a sequence of defined and refined steps. The research will also investigate the viability of a school-based gatekeeper program for primary and secondary school teachers that could be quickly and inexpensively implemented in a large number of schools.

How people react to suicidal ideation: The effect of suicide literacy, suicide stigma, and expressive suppression.

The purpose of this study is to understand the role of suicide literacy and suicide stigma in laypeople's intention to recommend professional help in Korea. Additionally, the study focuses on the role of expressive suppression as a sociocultural factor. Participants read vignettes depicting either subclinical distress or suicidal ideation and answered questions measuring suicide literacy, stigma, and expressive suppression. Mediated moderation analyses were used to examine the interactions between these factors. The result found the significant effect of expressive suppression. The mediating effect of suicide stigma on the relationship between suicide literacy and recommendation of professional help was significant for those who do not suppress their emotions. This result indicates that when individuals were not hesitant to express negative emotions, high suicide literacy lowered suicide stigma and led to more willingness to recommend professional help. The results showed that expressive suppression acts as a barrier deterring Koreans from professional help for their mental health. The findings underscore the importance of sociocultural factors such as expressive suppression in developing suicide prevention strategies.

Suicide literacy levels of nursing students: A cross-sectional study

Suicide literacy levels of nursing students: A cross-sectional study

A survey of suicide literacy in Japanese school teachers

School teachers are in a unique position to recognize suicide-related problems in their students and to appropriately support them; teachers may need high levels of suicide literacy. However, few studies have examined current levels of suicide literacy in teachers. This study aimed to investigate suicide literacy in school teachers. Teachers (n = 857) from 48 Japanese schools (primary and junior-/senior-high) answered a self-administered questionnaire assessing (a) knowledge about suicide, (b) intention to ask about students’ suicidal thoughts/plans, and (c) attitudes towards talking to students with mental health problems. The average proportion of correct answers to the knowledge questions (10 items) was 55.2%. Over half of the teachers knew that suicide is a leading cause of death in adolescents (55.0%), and that asking about suicidality is needed (56.2%). Half of the teachers intended to ask students about their suicidal thoughts (50.2%) and fewer intended to ask about experiences of planning suicide (38.8%). Most of the teachers (90.4%) agreed with the idea that talking to students with mental health problems was a teacher’s responsibility. Intention to ask about students’ suicidal thoughts/plans were higher in teachers in their 20s (vs. 40s–60s) and working at junior-/senior-high schools (vs. primary schools). Suicide literacy in Japanese school teachers was observed to be limited. However, teachers felt responsibility for helping students with mental health problems. The development and implementation of education programs may help improve teachers’ suicide literacy, which, in turn, could encourage effective helping behaviors of teachers for students struggling with suicidality.

Effectiveness of a localised and systematically developed gatekeeper training program in preventing suicide among Chinese adolescents.

To combat the pressing issue of contemporary suicide rates, an effective Life Gatekeeper training program was developed to educate school teachers in identifying and intervening with at-risk students. Two single-arm sequential studies evaluated the program's effectiveness, spanning implementation science stages from design to refinement.The initial study employed face-to-face training (FTF), followed by a standardized video-based 'Train-the-trainer' (TTT) approach. In Study 1, post-intervention and one-month follow-up results showed improved suicide literacy, reduced stigma, and increased willingness to intervene among gatekeepers. The revised TTT program (study 2) also yielded reduced stigmatization and improved intervention competence. In addition, six out of twenty teachers exhibited gatekeeper behaviors. In conclusion, both delivery methods proved effective, particularly the practical application of the TTT version, although further research is warranted to examine long-term effectiveness of the program.

Evaluation the validity and reliability of persian short form of the literacy of suicide scale (LOSS): a methodological study in 2022

IntroductionThis research was conducted with the aim of evaluating the validity and reliability of Persian short version of the Literacy of Suicide Scale (LOSS) among the general population.MethodsThis methodological study was conducted to evaluate the validity and reliability of Persian short form of LOSS among the general population, using a sample of 1175 participants in Iran, 2022. Participants were entered to study using method of proportional stratified sampling. The validity of Persian short form of LOSS was checked by four measures of validity: qualitative face validity, qualitative content validity, EFA (exploratory of factor analysis), and CFA (confirmatory factor analysis). The measure of reliability of Persian short form of LOSS was checked by three reliability of McDonald omega coefficient, ICC (Intraclass Correlation Coefficient), and Cronbach’s alpha coefficient.ResultsBased on the findings of EFA, 4 components with eigenvalues > 1 were extracted and these 4 factors were able to explain 57.96% of variance. In EFA section, only 1 question was deleted due to entry into the non -relevant sub –scale. Based on the results of CFA, all items had the factor loading greater than 0.4 and none of the items were removed at this stage. In CFA, based the results of goodness-of-fit indexes for example: χ2/df = 2.077, NFI: 0.957, IFI = 0.977, RMSEA = 0.030, GFI: 0.988, and PGFI = 0.569, the final mode was approved with 11 items and 4 factors. In this study for all items, Cronbach’s alpha coefficient was 0.739, McDonald omega coefficient was 0.753, and ICC was 0.860. Finally, the Persian short form of LOSS was approved with 11 items and four dimensions of signs/ symptoms with 3 questions, the risk factors with 2 questions, treatment/ prevention with 2 questions, and causes/ triggers with 4 questions.ConclusionThe Persian short form of LOSS with 11 items and four subscales is a valid and reliable scale to survey the suicide literacy status in the general population.

Literacy and stigma of suicide among Islamic religious leaders (Imams) in Bangladesh: a cross-sectional study

Literacy and stigma of suicide among religious leaders affect help-seeking behaviours for suicidal behaviour in the community. We did not find any study assessing the literacy and stigma level among religious leaders in Bangladesh to date. We aimed to assess the status of suicide literacy and stigma and factors related to them among religious leaders in Bangladesh. This cross-sectional study was conducted from April to July 2023. Data were collected from 162 religious leaders (Imams) by self-reporting instrument purposively. The instruments contain several parts, like socio-demographic variables, suicidal behaviour, suicide literacy, and stigma towards suicide. The mean literacy score was 4.75 ± 1.56 (range 1–8). We did not find any relationship between suicide literacy and stigma. We found a positive correlation between stigma and isolation subscales (r = 0.67; p < 0.001) and a negative correlation between isolation and glorification subscales (r = −0.28; p < 0.001). Suicide literacy was higher in Imams with better income (p = 0.025), and Imams who observed suicide in close persons (p = 0.017). Isolation was lower in Imams with a family history of suicide attempts (p = 0.036), and lifetime suicidal thoughts (p = 0.020) whilst glorification was higher in persons with suicide attempts (p < 0.007). In conclusion, suicide literacy among the Islamic religious leaders (Imams) of Bangladesh is low and similar to the levels among the students. Strategies are warranted to improve the situation, as religious leaders can play important roles in suicide prevention and help-seeking for suicidal behaviour.

Evaluating suicide attitudes and suicide literacy in adolescents

Background Two of the most common modifiable barriers to help-seeking for mental health problems during adolescence are stigma and poor mental health literacy. However, relatively little is known about stigma as it relates to suicide, and knowledge about suicidality in this age group. Aims To assess levels of suicide literacy and suicide attitudes in an adolescent sample, and to identify correlates of these constructs. Methods Data were drawn from the pre-intervention survey of the Sources of Strength Australia Project. A total of 1019 adolescents aged between 11 and 17 years participated. Suicide literacy and attitudes were measured alongside potential correlates including psychological distress, suicidal ideation, mastery, previous exposure to suicidal thinking and behaviour, and demographics. Results Participants more strongly endorsed attitudes attributing suicide to isolation/depression, compared to attitudes glorifying or stigmatising suicide. Gaps in knowledge about suicide included the risk factors, signs and symptoms. Key correlates of suicide attitudes and literacy included age, gender and cultural background. Conclusion Findings highlight the need for further education activities in schools and public awareness campaigns that address the gaps in suicide knowledge and attitudes. Such activities would assist in the identification of suicide risk among young people and improve help-seeking in this population.

Pesticides and passion: a qualitative psychological autopsy study of suicide in Guyana

The suicide rate in Guyana has consistently ranked in the top ten globally, yet there is only limited literature related to the context in which these suicides occur. This study aims to better understand the psychosocial circumstances and characteristics of suicides in Guyana. This case series study utilised a qualitative psychological autopsy method. One to three informants per deceased person (N=31) were interviewed regarding the lives of 20 Guyanese who died by suicide (14M, 6F, aged 10-74 years). Interpretative Phenomenological Analysis was utilised for the data. Four superordinate themes were identified: Interpersonal Conflict, Trauma, Health, and Unknown Reasons. Interpersonal conflict included subordinate themes of Domestic Abuse, Marital Separation, and Financial Disputes. Health included subordinate themes of Physical Health and Mental Health. Pesticide poisoning was the method used by Guyanese people whose suicide was triggered primarily by interpersonal conflict. The findings illustrate the complexities of suicide in Guyana and the importance of adopting a biopsychosocial perspective to suicide prevention. Suicide prevention should include mental health and suicide literacy training of medical professionals. It is recommended that the importation of highly toxic pesticides be restricted, and that less toxic substitutes be promoted. Convenience sampling, recall bias, and limited informants are limitations of this study. Future research should focus on suicidal behaviour using larger sample sizes. This research was supported by an Australian Government Research Training Program Scholarship through Griffith University Australia.

Are Parents the Key? How Parental Suicide Stigma and Suicide Literacy Affect Help-Seeking Attitudes and Intentions for their Child

Suicide is the leading cause of death among Australian young people, yet rates of help-seeking for suicidal ideation and behaviors in this population are concerningly low. In this study, the relationships between parental suicide stigma, parental suicide literacy, and their attitudes and intentions toward seeking professional help for their child if they were to express thoughts of suicide are investigated. Understanding this influence is critical given parents are key facilitators of their child’s access to and engagement with professional mental health services. An online survey was administered to 302 parents of children aged-12–18 (Mage = 45.36, SDage = 6.23; 91.4% female). Parental suicide stigma was significantly associated with more negative help-seeking attitudes and lower help-seeking intentions. Other significant predictors of more positive help-seeking attitudes included parental self-efficacy and having a child with no history of suicidal ideation. Higher help-seeking intentions were associated with female gender, living in an urban area, and positive help-seeking attitudes. Parental suicide literacy was not significantly associated with help-seeking. Practically, outcomes of this study may inform the development and implementation of targeted education programs to increase parental help-seeking for their children.

Literacy and Stigma of Suicide among Medical Students of Bangladesh: Status and Associated Factors

Background: Literacy and stigma of suicide have been poorly assessed across the groups in Bangladesh even though they affect help-seeking behavior and have an enduring effect on suicide prevention. Objectives: We aimed to determine the status of literacy and stigma of suicide along with associated factors among medical students of Bangladesh. Methods: This study was conducted from January to June 2022 among 172 undergraduate medical students in Bangladesh by Google form. Literacy and stigma were assessed by the Bangla literacy of suicide scale (LOSS[1]B), and the Bangla stigma of suicide scale (SOSS-B). Results: The mean age of the participants was 22.81 ± 1.8 (range 19-28) years, 64% were females, and 95% were unmarried. The LOSS-B score ranged from 0-10 with a mean of 4.72 ± 1.97. The literacy was significantly higher in married students, students with chronic physical illness and psychiatric disorder, lifetime suicidal thoughts, and suicidal thoughts in the past year while stigma was significantly lower among females, with mental disorders, with a family history of suicide attempts, and students with suicidal thoughts in a lifetime and past year. Conclusions: The study determines the level of suicide literacy and stigma towards suicide among medical students of Bangladesh. Having history of previous mental health services consumption of mental health services and past suicidal behavior revealed a better level that indicates the effectiveness of mass media campaigns for raising awareness and reducing stigma. Bangladesh Medical Res Counc Bull 2022; 48(3): 225-230