Suicide Prevention Strategies Research Articles

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

Effectiveness of a targeted brief intervention for recent suicide attempt survivors: a randomised controlled trial protocol

IntroductionEffective, brief, low-cost interventions for suicide attempt survivors are essential to saving lives and achieving the goals of the National Strategy for Suicide Prevention and Zero Suicide. This study aims...

The National Suicide Prevention Strategy of India: New vistas, new hopes

The National Suicide Prevention Strategy of India: New vistas, new hopes

Is lethality different between males and females? Clinical and gender differences in inpatients suicide attempters

IntroductionAccording to the gender paradox,in suicidology an important sex difference has been reported with a preponderance of females in nonfatal suicidal behavior and a preponderance of males in completed suicide.The lethality of suicidal behavior in females is lower most likely because males choose more violent suicide methods.Furthermore,women more frequently present traditional risk factors for suicide than do men,including depression,childhood sexual abuse, and prior suicidal ideation and attempts.ObjectivesThe purpose of this study was to explore possible clinical differences between male and female psychiatric inpatients who had recently attempted suicide.We hypothesized that clinical characteristics such as psychiatric diagnosis,the methods and lethality of the suicide attempt,the history of suicide attempts,age at onset of psychiatric illness,the presence of substance or alcohol use and the length of stay differ between male and female suicide attempters.MethodsThe study included 177 adult inpatients at the University Psychiatric Clinic, Sant’Andrea Hospital, Sapienza University of Rome hospitalized following a suicide attempt, between January 2018 and May 2022.Clinical features assessed included psychiatric diagnosis, method and lethality of suicide attempts using the Risk-Rescue Rating Scale, the history of suicide attempts, age at onset of psychiatric illness, the presence of substance or alcohol use, and the length of stay.All statistical analyses were performed with the Statistical Package for Social Sciences(SPSS 27.0).ResultsMales and females differed according to the method used for suicide attempt(x23=10.96,p<0.05),the scores for risk and rescue(t175=2.55,p<0.05;t146.6=-1.99,p<0.05,respectively),and the length of stay(U= 3084.5,p<0.05).Females were more likely to use drug/poisoning ingestion as method for suicide attempt than were males(72.8% vs.51.4%),whereas males were more likely to use hanging than were females(20.3% vs. 6.8%).The risk score was higher for males(3.76±0.68)than for females(3.49±0.72),and the rescue score was higher for females than for males(2.79±1.09 vs. 2.43±1.22).Finally,the length of stay was longer for males than for females(10.66±8.09 vs. 8.25±6.48).These results confirm the role of difference in suicide methods used by males and females for explaining the “gender paradox.”ConclusionsThe present study illustrates the usefulness of the Risk-Rescue Rating Scale which is a descriptive and quantitative method of assessing the lethality of suicide attempts.Identifying sex related characteristics of suicide risk in patients is important for implementing specific suicide prevention strategies to reduce suicidal intent, psychological pain and rehospitalization in patients with psychiatric disorders.Men and women may need different strategies for the prevention of future suicidal behavior.Disclosure of InterestNone Declared

The association between victimization experiences and suicidality: The mediating roles of sleep and depression

BackgroundPrior work suggests that multiple forms of victimization were associated with higher suicide risk among adolescents. However, the mechanisms underlying this association remain unclear. The present study aimed to understand the relationships between the multiple forms of victimization and suicidality by examining the potential mediators of sleep duration and depression. MethodsData for this study came from the 2019 Youth Risk Behavior Survey (YRBS). The hypothesized mediation model included 13,677 American adolescents in 9th through 12th-grade students (48.6 % female) were analyzed using Mplus 7.4, and suicidality (including suicidal ideation, plan, and attempts) as the outcome variables and the multiple forms of victimization (including bullying at school, being threatened at school, electronic bullying, sexual victimization, sexual dating victimization, and physical dating victimization) as the main explanatory variable. ResultsThe relationships between the multiple forms of victimization and suicide risk were mediated by sleep duration, depression, and also serially mediated by sleep duration and depression. LimitationsThis is a cross-sectional study, and the results cannot inform the causality between these variables. This investigation only included adolescent sleep duration, and other specific sleep problem indicators should be included. ConclusionsLonger sleep duration is an important protective factor, pointing the way forward for developing suicide prevention strategies and targeted interventions for adolescents.

Secular trends of suicide risk for residents in mainland China (2004 to 2019): An updated age–period–cohort analysis

BackgroundThe overall suicide rate in China has dropped substantially since the 1990s, but a slowdown in the decrease and even a reversing trend was observed in specific groups in recent years. This study aims to investigate the latest suicide risk in mainland China by using the age-period-cohort (APC) analysis. MethodThis population-based multiyear cross-sectional study included Chinese ages 10 to 84 years using data from the China Health Statistical Yearbook (2005–2020). Data were analyzed by the APC analysis and intrinsic estimator (IE) technique. ResultsThe data satisfactorily fit the constructed APC models. The cohort effect indicated a high risk of suicide among people birth in 1920–1944 and a sharp decline in the 1945–1979 cohort. The lowest risk occurred in the 1980–1994 cohort before a sharp increase in generation Z (birth years in 1995–2009). The period effect showed a declining trend since 2004. The age effect indicated that the suicide risk increased over time, except for a gradual decline from age 35 to 49. The suicide risk increased greatly in adolescents and reached the highest among the elderly. LimitationsThe aggregated population-level data and the non-identifiability of the APC model could result in bias in the accuracy of results in this study. ConclusionsThis study successfully updated the Chinese suicide risk from the age, period and cohort perspective using the latest available data (2004–2019). The findings enhance the understanding of suicide epidemiology and provide evidence supporting policies and strategies at the macro-level for suicide prevention and management. Immediate action is needed to focus on a national suicide prevention strategy that targets generation Z, adolescents and the elderly which will require a collaborative effort by government officials, public/community health planners and health care agencies.

Suicide risk model based on the interpersonal theory of suicide: evidence in three regions of Mexico

Background: Reports of suicidal behavior have increased in Mexico for years. In order to develop a more adequate suicide prevention strategy, it is necessary to understand its predictive factors, so the purpose of this research was to propose a model of suicidal risk in young people, taking into account one of the most current theories on the subject, Joiner's interpersonal theory. Method: A non-probabilistic sample of young people with suicidal ideation from three regions of Mexico was obtained by online survey (N=411), with mean age of 17.89 years (SD. 1.2), 336 women (81.8%), and 75 men (18.2%). Results: First, a multiple linear regression model was created to predict suicidal risk based on thwarted belongingness and perceived burden with 17% explained variance; then a second model was generated with the same variables and including other factors associated with suicide such as self-injury desires, impulsivity and suicide attempts, in addition to variables associated with family conflicts, improving the explained variance to 34%. Lastly, two properly adjusted structural equation models were obtained, one focused on suicidal risk (R2=.21; RMSEA=.026; CFI=.99) and the other on ideation (R2=.18; RMSEA=.070; CFI=.98). Conclusions: The main factors that explain suicidal risk are depressive symptoms, perceived burden and desires for self-injury. Further research on the effect of painful experiences as factors that could predict suicide attempt is suggested.

The mediating effect of distress tolerance on the relationship between stressful life events and suicide risk in patients with major depressive disorder

BackgroundDespite widespread acknowledgment of the impact of stressful life events on suicide risk, the understanding of the psychological mechanisms underlying the relationship between stressful life events and suicide risk in major depressive disorder (MDD) remain unclear. This study aim to examine whether the distress tolerance mediates the relationship between the stressful life events and suicide risk in patients with MDD.MethodsA cross-sectional study was carried out among 125 Chinese patients with MDD, mean age was 27.05 (SD=0.68) and 68.8% were females. The 17-item Hamilton Depression Rating scale (HAMD-17), the validated Chinese version of the Mini International Neuropsychiatric Interview (MINI) suicide module, Life Events Scale (LES) and Distress Tolerance Scale (DTS) were utilized to evaluate depressive symptoms, stressful life events, levels of distress tolerance, and suicide risk, respectively. Mediation analyses was used to test the mediation effect of distress tolerance on the relationship between stressful life events and suicide risk.ResultsThe ratio of suicide risk in patients with MDD was 75.2%. Pearson correlation analysis showed that stressful life events were positively correlated with suicide risk(r=0.182, p<0.05). Stressful life events(r=-0.323, p<0.01) and suicide risk(r=-0.354, p<0.01) were negatively correlated with distress tolerance. Mediation analyses showed that the direct path from stressful life events to suicide risk was not significant (B= 0.012, 95% confidence interval (CI) [-0.017, 0.042]). Stressful life events affected suicide risk indirectly through distress tolerance (B= 0.018, 95% CI [0.007, 0.031]), and the mediating effect accounted for 60.0% of the total effect.ConclusionDistress tolerance completely played a mediating role between stressful life events and suicide risk. Further suicide prevention and intervention strategies should focus on increasing levels of distress tolerance in patients with MDD.

Veterans Crisis Line Call Outcomes: Treatment Contact and Utilization

Crisis lines are a central component of suicide prevention strategies in the U.S. and for the Department of Veterans Affairs. The purpose of this study is to evaluate the impact of calling the Veterans Crisis Line on treatment contact and utilization. Call records from 599 veterans who called in 2019 were linked with medical records and analyzed in 2020. Multilevel generalized linear modeling examined pre-post changes in treatment contact (yes/no) and utilization (number of days of care). In the month after the call, 85% of callers made contact with health care, and 79% made contact with behavioral health care. Callers were more likely to make contact with health care in the month after the call than in the preceding month (AOR=6.27, 95% CI=4.22, 9.32) and more likely to make contact with behavioral health care (AOR=10.21, 95% CI=6.66, 15.67). Days of health care nearly doubled to 4.82, and days of behavioral health care more than doubled to 3.52. Among veteran callers who are linked to medical records, calling the Veterans Crisis Line may increase contact and utilization of health care and behavioral health care. These findings support crisis lines that are linked with healthcare systems in public health strategies for suicide prevention.

Youth Suicide During the First Year of the COVID-19 Pandemic.

To identify potential differential changes in youth suicide deaths associated with the coronavirus disease (COVID-19) pandemic to better inform suicide prevention strategies. This cross-sectional study analyzed national suicide data for US youth aged 5 to 24 years from 2015 to 2020. Annual and monthly numbers of suicides were extracted overall and by sex, age, race and ethnicity, and method. Expected suicides were modeled from the trend in monthly deaths before COVID-19 (January 1, 2015-February 29, 2020), by using interrupted time-series analyses with quasi-Poisson regression. Rate ratios (RR) and corresponding 95% confidence intervals (CI) were used to compare expected and observed suicides during the first 10 months of COVID-19 (March 1, 2020-December 31, 2020). Among 5568 identified youth suicides during the 2020 pandemic, 4408 (79.2%) were male, 1009 (18.1%) Hispanic, 170 (3.3%) non-Hispanic American Indian/Alaska Native, 262 (4.7%) Asian/Pacific Islander, 801 (14.4%) Black, and 3321 (59.6%) white. There was a significant increase in overall observed versus expected youth suicides during the COVID-19 pandemic (RR = 1.04, 95% CI = 1.01-1.07), equivalent to an estimated 212 excess deaths. Demographic subgroups including males (RR = 1.05, 95% CI = 1.02-1.08), youth aged 5 to 12 years (RR = 1.20, 95% CI = 1.03-1.41) and 18 to 24 years (RR =1.05, 95% CI = 1.02-1.08), non-Hispanic AI/AN youth (RR = 1.20, 95% CI = 1.03-1.39), Black youth (RR = 1.20, 95% CI = 1.12-1.29), and youth who died by firearms (RR = 1.14, 95% CI = 1.10-1.19) experienced significantly more suicides than expected. Suicide deaths among US youth increased during COVID-19, with substantial variation by sex, age, race and ethnicity, and suicide method. Suicide prevention strategies must be tailored to better address disparities in youth suicide risk.

Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments

Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool. To compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata. The Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023. This study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY's continuous outcome is the predicted probability of an SA. Of 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively). This study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.

India's National Suicide Prevention Strategy: considerations to enhance desired outcomes

India's National Suicide Prevention Strategy: considerations to enhance desired outcomes

National Suicide Prevention Strategy of India: implementation challenges and the way forward

National Suicide Prevention Strategy of India: implementation challenges and the way forward

Demographic and psychosocial factors associated with recent suicidal ideation and suicide attempts among trans and gender diverse people in Australia.

Correlates of suicidal ideation and suicide attempts among a large cross-section of trans and gender diverse populations in Australia were examined. A national survey was conducted that included 1466 trans and gender diverse participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts. Overall, 62.4% reported suicidal ideation and 9.5% suicide attempt in the past 12months. The likelihood of suicidal ideation was higher for younger participants or those who felt treated unfairly or socially excluded due to their gender identity in the past 12months. It was lower for those with a postgraduate degree, who felt accepted by family or work, or who felt their gender identity was respected when accessing a mainstream medical clinic in the past 12months. The likelihood of suicide attempts was greater for those aged younger or who had recently experienced sexual harassment based on their sexual orientation or gender identity, and lower for those who were non-binary. Urgent attention for suicide prevention is necessary for trans and gender diverse communities. These findings point to a range of risk and protective factors, which may help inform the targeting and design of suicide prevention strategies.

Hospital inpatient suicides: A retrospective comparison between psychiatric and non-psychiatric inpatients in Milan healthcare facilities.

Inpatient suicide in hospitals is a worrying phenomenon that has received little attention. This study retrospectively explored the socio-demographic, clinical, and suicide-related characteristics of hospital inpatient suicides in Milan, Italy, which were collected at the Institute of Forensic Medicine during a twenty-eight-year period (1993-2020). In particular, this study compared the features of hospital inpatient suicides in patients with and without psychiatric diagnoses. Data were collected through the historical archive, annual registers, and autopsy reports, in certified copies of the originals deposited with the prosecutors of the courts. Considering the global sample, inpatients were mainly men (N= 128; 64.6%), with a mean age of 56.7 years (SD ± 19.8), of Italian nationality (N= 176; 88.9%), admitted to non-psychiatric wards (N= 132; 66.7%), with a single illness (N= 111; 56.1%), treated with psychotropic medications (N= 101; 51%), who used violent suicide methods (N= 177; 89.4%), died of organic injuries (N= 156; 78.8%), and outside the buildings (N= 114; 72.7%). Comparing psychiatric and non-psychiatric inpatients, suicide cases with a non-psychiatric diagnosis were predominantly men (N= 48; 76.2%), hospitalized in non-psychiatric wards (N= 62; 98.4%), assuming non-psychotropic drugs (N= 37; 58.7%), and died in outside hospital spaces (N= 54; 85.7%). A fuller characterization of suicide among hospitalized inpatients requires systematic and computerized data gathering that provides for specific information. Indeed, this could be valuable for inpatient suicide prevention strategies as well as institutional policies.

Notifying university students' emergency contacts in mental health emergencies: Multi-year analysis of student consent policy preferences

Information sharing is a frequently discussed yet divisive suicide prevention strategy in universities. This study aimed to investigate which students are most and least likely to opt-in to university permission to notify an emergency contact if there are serious concerns about their mental health. Routine cross-sectional data were obtained from 29,799 students in 2020 and 31,998 students in 2021 within a UK university. The proportion of students opting-in to a ‘consent to contact policy’ across years was summarised descriptively. Multiple logistic regression models examined the odds of students opting-in dependent on student characteristics (probable clinical depression, age, gender identity, sexuality, ethnicity, home/international student status, disability, study mode and level of study). Most students opted-in to the policy in 2020 (91.2%, n = 27,146) and 2021 (90.4%, n = 28,912). Probable clinical depression (OR = 0.63, 95% CI = 0.54 to 0.72) and gender identity different from sex (OR = 0.63, 95% CI = 0.44 to 0.90) had the strongest associations with not opting-in in 2020. Identifying as male, lesbian/gay/bisexual, Asian ethnicity, declaring a disability, and being a taught postgraduate student were also predictive of not opting-in. These results were replicated in the 2021 dataset. Some of the most vulnerable students appear least likely to opt-in. Insights are offered about potential gaps in universities' access to emergency contacts to prevent serious harm or loss of life. Further research is required into why the groups identified in this study are less likely to opt-in and what additional support they may require.

Suicide Risk Help-Seeking Among Middle- to Old-Age Adults: A Systematic Review.

Suicide has become a major public health concern worldwide and in the United States. Rates of suicide increase during the life course and are highest among middle- to old-age adults. Help-seeking represents a crucial coping mechanism that can mitigate suicide risk. Yet, less is known about suicide risk help-seeking, especially among these age groups. To address this knowledge gap, a systematic review of existing literature was performed to obtain a refined understanding of help-seeking for suicide risk among middle- to old-age adults. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic databases and key journals with suicide and/or gerontology focuses were searched to identify peer-reviewed publications in English between 2010 and 2020. A total of 4 732 unduplicated publications were screened for relevance based on titles and abstracts, of which 52 were reviewed in full text. Twenty-four articles met inclusion criteria and were included in the qualitative synthesis. These articles discussed a range of topics, including the prevalence of service utilization, service use prior to a suicide death, and correlates of help-seeking. In general, the prevalence of service utilization was low and varied by suicidal history (eg, higher prevalence among individuals with a history of suicide attempts than those with suicide ideation only). Key facilitators (eg, current or history of suicidal thoughts, plans, or attempts) and barriers (eg, stigma) for service use and help-seeking were also identified. Findings highlight the need for future studies and tailored services to improve age-appropriate and culturally responsive suicide prevention and intervention strategies for middle- to old-age adults.

Examining Suicidal Thoughts and Behaviors Among Ohio Youth with Oppressed Identities Using the 2019 Ohio Youth Risk Behavior Survey

Background: Suicide is the second leading cause of death among youth aged 10 to 14 years and third for those aged 15 to 24 years in the United States and in Ohio. Suicidal thoughts and behaviors disparately affect youth with oppressed identities, including those with oppressed racial, ethnic, gender, and sexual minority identities. The purpose of this study was to examine the relationship between self-reports of suicidal thoughts and behaviors among Ohio youth with oppressed identities. This research also contextualizes relationships between these indicators through the context of intersectionality. Methods: This cross-sectional descriptive study used responses from the 2019 Ohio Youth Risk Behavior Survey (YRBS; n = 1263) to examine the relationships between identity variables and suicidal thoughts and behaviors through a series of logistic regression models. Results: Female youth have higher odds of reporting persistent feelings of sadness and hopelessness and seriously considering suicide than male youth. Lesbian, gay, or bisexual (LGB) youth have higher odds of reporting all outcome measures of suicidal thoughts and behaviors (STBs), and youth with oppressed racial and ethnic identities were in general more likely to report higher odds of STBs when compared to White youth. Conclusion: Suicidal thoughts and behaviors disparately affect youth with these oppressed identities. Our findings suggest further examination of these youth nationally may influence public health suicide prevention strategies. Implica-tions also suggest that researchers, practitioners, and organizations across the spectrum of youth suicide prevention in Ohio should understand the increased risk that youth with multiple, intersectional oppressed identities face for suicide.

Risk profiles of suicide attempts among girls with histories of commercial sexual exploitation: A latent class analysis

BackgroundGirls impacted by commercial sexual exploitation (CSE) in the juvenile legal system are three times more likely to have suicide attempts than girls without histories of exploitation. Yet, research on risk profiles and correlates that contribute to elevated suicide risk among girls with CSE histories remains scant. ObjectiveWe sought to examine suicide attempts profiles among CSE-impacted girls in the juvenile legal system. Participants and settingWe partnered with a specialty court for CSE-impacted youth in Los Angeles County. MethodsData were collected from case files of the 360 girls participating in the court from 2012 to 2016. Latent class analysis was used to identify their profiles of risk indicators. ResultsFour risk profiles for suicide attempts emerged: (1) Parental Incarceration (PI; 30 %), (2) Child Welfare Contact (CWC; 25 %), (3) Disruptive Behavior and Sleep Problems (DBS; 25 %), and (4) Pervasive Risk (PR; 22 %). Among youth in the PI group, 5 % had a suicide attempt; however, contrary to our hypothesis, no youth in the CWC group had a suicide attempt. Rates of suicide attempt were significantly higher among youth in the DBS group, as 14 % had a suicide attempt. As hypothesized, youth in the PR were associated with higher risk of suicide attempts, with 28 % reporting a prior suicide attempt. ConclusionsFindings underscore the need for standardized suicide screenings and treatment referrals for girls with CSE histories and suggest an important opportunity for multidisciplinary collaboration with courts to improve suicide prevention strategies. The present study also supports the importance of examining risk across the socioecological context.

Suicide prevention and postvention strategies in the times of the Covid-19 pandemic

O presente estudo teve o objetivo de mapear evidências científicas sobre as estratégias destinadas à prevenção e à posvenção do suicídio no decurso da pandemia da Covid-19. Para isso, foi realizada uma scoping review entre o período de 17 de dezembro de 2021 a 8 de fevereiro de 2022, nas seguintes bases de dados: MEDLINE via PubMed, ISI of Knowledge via Web of Science, Cochrane Central Register of Controlled Trials (Central), Excerpta Medica database (Embase), Scopus, Latin American and Caribbean Health Sciences Literature (Lilacs) e Psychology Information (PsycINFO). Foram analisados 11 estudos com evidências de que a psicoterapia cognitiva comportamental, a psicoeducação do modelo cognitivo do comportamento suicida e a flexibilidade psicológica têm potencial para prevenir mortes por suicídio.