Suicide Prevention Research Articles

Supplemental Material for Cultural Spanish Adaptation, Factor Structure, and Reliability of Implementation Science Instruments for Suicide Prevention

Supplemental Material for Cultural Spanish Adaptation, Factor Structure, and Reliability of Implementation Science Instruments for Suicide Prevention

Are veterans willing to assist with firearm safety for suicide prevention?

ABSTRACT Veterans in the United States are affected by suicide at higher rates than the general population. This may be due to a higher probability for veterans to use more lethal methods of suicides such as firearms. While veterans often decline to disclose suicidal tendencies to healthcare providers, they show higher connectedness and willingness to heed the advice of peers. Considering this information, it is important to analyze how veteran peers could assist in a suicidal crisis. Veteran responses (n = 1,247) to the Gatekeeper Behavior Scale (GBS) and Firearm Safety Scale (FSS) were analyzed to determine predictive traits of willingness to assist a peer securely store or disable firearms during a suicidal crisis. Results show that veterans are willing to assist in securing firearms to prevent suicide death but are more willing to do so by locking, removing or disabling the firearms than storing them with law enforcement. Older veterans were also more likely to report a willingness to intervene than their younger peers. Of the GBS predictors, only the Likeliness to Help subscale predicted a willingness to intervene with firearm safety. Recommendations for training and interventions that further encourage helping behavior during suicidal episodes are discussed.

Представления сотрудников полиции о взаимодействии с суицидентами

Currently, the problem of suicide prevention is not losing its relevance. In many countries of the world, there remains a need to take measures to prevent suicide, provide access to quality psychological help and create a supportive environment for people. The purpose of this article is to analyze the perception of police officers about interaction with suicides and offer practical recommendations for organizing effective communication between police officers and suicides. The subject of the study is the perception of police officers about the peculiarities of behavior when interacting with suicides. The study involved 41 respondents aged 19 to 37 years. It should also be noted that police officers have an idea of the basic rules of behavior with citizens prone to suicide. It was revealed that police officers have a general idea of the behavioral characteristics of individuals showing signs of suicidal behavior, and the awareness of officers of the general rules of behavior with suicides is noted. At the same time, it is necessary to constantly expand knowledge, improve the skills of interaction of police officers with potential suicides.

Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis

BackgroundSuicidal persons’ contacts with services present a key opportunity for suicide prevention. However, interventions by services are not always effective. A deeper understanding of suicidal service users’ agency and its implications may facilitate the provision of meaningful responses to help-seeking during suicidal crises. This abductive study explores the recovery-related agency of suicide attempt survivors and the perceived role of interactions with services in facilitating or hindering it.MethodsFourteen Finnish suicide attempt survivors were interviewed in-depth on their experiences of interacting with services during a recent suicidal episode. An operationalization of recovery-related agency as the expressed ability to take (mental or physical) action in a direction perceived as aiding recovery from suicidality (i.e., the coupling of recovery-related intentionality and power) was used to explore transcribed interviews through directed content analysis. Data were further categorized based on whether the service context was perceived as helpful or unhelpful to recovery efforts.ResultsAll participants expressed both agency and non-agency in relation to their recovery process. The relational context provided by services was presented as highly relevant for the achievement and sustainability of recovery-related agency as well as for participants’ experience of safety in instances when agency was lacking. The results are presented as a typology of recovery-related agency in its perceived relational context, with the categories of sustained agency, strained agency, contained non-agency and uncontained non-agency.ConclusionsThe concept of agency helped capture important aspects of suicidal individuals’ recovery-related efforts and the role of services in facilitating or hindering them. The findings illuminate the value of viewing suicidal service users as agents of their own recovery process as well as the potential costs of ignoring this perspective in service delivery and design.

Associations among psychological health problems, intimate-relationship problems, and suicidal ideation among United States Air Force active-duty personnel

ABSTRACT Linkages among psychological health problems, intimate relationship distress, and suicide risk have been widely studied, but less is known about how these factors interact, especially in military populations. With steady increases in suicide rates among active military and post-service members (SMs), it is critical to better understand the relation among known risk factors. The current study addresses this gap by testing a model hypothesizing that the association between intimate-relationship problems and suicidal ideation is mediated by individual mental health symptoms. We tested this model on a sample of 862 active-duty Air Force members in committed relationships. The sample consisted of 35.0% women and 64.8% men, with an average age of 21.9 years and a mean relationship length of 2.8 years. Findings supported the hypothesized statistical mediation model. Results indicated that relationship problems contribute to psychological health problems, which, in turn, are related to suicidal ideation. These findings may help direct suicide intervention and prevention protocols that consider intimate relationship distress as a significant risk factor. Limitations and further implications for policies regarding suicide prevention in the armed forces are discussed.

Mobile Apps for the Personal Safety of At-Risk Children and Youth: Scoping Review.

Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be "at risk." A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users' experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used. A total of 1986 articles were identified, and 41 (2.1%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44% of apps), bullying and school violence prevention (n=2, 22% of apps), self-harm and suicide prevention (n=2, 22% of apps), and homeless youth support (n=1, 11% of apps). Of the 41 articles, 25 (61%) provided data solely on app descriptions and features, while the remaining 16 (39%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users' experiences, and effectiveness. Four articles reported on app use, 3 (75%) of which reported relatively high app use. Data on users' experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40% dating and sexual violence prevention; n=2, 40% self-harm and suicide prevention; and n=1, 20% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95% CI. Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth.

Trace Lithium for Suicide Prevention and Dementia Prevention: A Qualitative Review

Background: Anti-manic effects of lithium and the nature of trace element in lithium were first observed in 1949. In this review, we explore the potential effects of trace lithium in the prevention of suicide and dementia. Methods: This is a qualitative and non-systematic review. Results: While most studies to date have been cross-sectional, limiting the establishment of causal relationships, the potential benefits of trace lithium for suicide prevention and dementia prevention are notable, especially in the absence of radical treatments for suicide and dementia. Furthermore, trace lithium appears to lack many of the adverse effects associated with so-called therapeutic lithium levels. Conclusions: The present findings suggest that trace lithium may be associated with lower suicide rates and reduced dementia rates. Probably, trace lithium may inhibit testosterone and thereby mitigate aggression and impulsivity and decrease suicide. Also, trace lithium may inhibit GSK-3β and thereby lower amyloid β and tau hyperphosphorylation and inhibit pro-inflammatory cytokines such as IL 6 and IL 8 and thereby mitigate inflammation, whereas trace lithium may promote BDNF and neurogenesis in the general population.

Long-Term Impact of the Bloor Viaduct Suicide Barrier on Suicides in Toronto: A Time-Series Analysis: Effet à long terme de la barrière anti-suicide du viaduc Bloor sur les suicides à Toronto : une analyse chronologique.

A suicide prevention barrier was installed at Toronto's Bloor Viaduct bridge in 2003. It was associated with short-term location substitution, possibly mediated by media effects that did not persist over 1 decade. The long-term impact of the barrier is unknown. We examined rates of suicides by jumping from the Bloor Viaduct, other bridges and by other methods using coroner's records in Toronto (1998-2020). We used interrupted time-series Poisson regression analyses to model changes in quarterly bridge-related suicides after barrier installation. A secondary analysis explored the potential substitution effects of suicide by other methods. Of 5219 suicides from 1998 to 2020, 303 were by jumping from bridges. After controlling for covariates, installation of the Bloor Viaduct suicide barrier was associated with a 49% step decrease in bridge-related suicide in the next quarter in Toronto (incidence rate ratio [IRR] = 0.51, 95% CI, 0.30 to 0.86) with no rebound increase in bridge-related suicide during the subsequent 17 years after the original drop (IRR = 0.99, 95% CI, 0.96 to 1.03). There was also no associated change in suicides by other methods after the barrier (IRR = 1.04, 95% CI, 0.90 to 1.20). Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier. They support the long-term utility of structural interventions at high-frequency sites for suicide.

Exploring the Influence of Masculine Norms on Suicidal Ideation and Help-Seeking Behavior.

Background: Men account for 75% of all suicide deaths in Australia. Societally dominant masculine norms have been theorized to be linked with suicidality and reduced help-seeking. However, evidence is needed to establish this relationship further. Aims: To further understand the relationships between 11 masculine norms, suicidal ideation, and mental health help-seeking behavior longitudinally in Australian males. Method: We analyzed data from a cohort of 8,214 males (aged 18-55 years), using logistic regression to examine if conformity to any of the 11 masculine norms measured by the Conformity to Masculine Norms Inventory (CMNI-22) at Wave 1 was associated with suicidal ideation and help-seeking at Wave 2. Results: Analyses revealed that being in the high conformity group for the norm of emotional control at Wave 1 was associated with higher odds of suicidal ideation longitudinally. Being in the low conformity group for the global construct of masculine norms and the specific norms of emotional control and power over women was associated with higher rates of mental health help-seeking behavior longitudinally. Limitations: The CMNI-22 scale's limited construct validity and the use of a single-item measure for suicidal ideation may have restricted the accurate capture of masculine norms and suicidal behaviors in Australian men. Conclusion: These results provide support for the contention that suicidality is a profoundly gendered phenomenon by showing an association between masculine norms and suicidal ideation in men. These norms should be a point of focus of male suicide prevention initiatives.

National Incidence of Nurse Suicide and Associated Features.

The aim of this study was to estimate the national incidence of nurse suicide. Nurses are at a higher risk of suicide than nonnurses; however, data have been limited since 2018. This study used a retrospective cohort design using 2017-2021 National Violent Death Reporting System suicides. Female nurses had higher suicide rates than female nonnurses in 2018 (incidence rate ratio, 1.21 [95% confidence interval (CI), 1.05-1.39]), 2019 (1.41 [95% CI, 1.23-1.60]), 2020 (1.26 [95% CI, 1.08-1.45]), and 2021 (1.35 [95% CI, 1.17-1.55]), whereas male nurses were comparable with male nonnurses. Nurses had higher odds of mental health problems (adjusted odds ratio, 1.28 [95% CI, 1.13-1.46], P < .001), job problems (1.60 [95% CI, 1.33-1.92], P < .001), and use of poisoning (1.54 [95% CI, 1.37-1.74], P < .001). Nurses had higher odds of using opioids, cardiovascular/diabetic agents, and drugs not prescribed for home use. Female nurses are at a higher risk of suicide than other females. Multimodal nurse suicide prevention strategies remain indicated.

A qualitative exploration of question, persuade, refer (QPR) gatekeeper training by the alabama suicide prevention and resources coalition

ObjectiveSuicide remains one of the leading causes of death in the United States. The goal of this research was to explore the experiences of individuals who participated in the Question, Persuade, Refer (QPR) Training and subsequently intervened during a suicidal crisis post-QPR training. MethodsThe study team conducted key informant interviews with eight participants who completed QPR Gatekeeper Training between September 2018 and March 2019. Study participants worked in occupations with some exposure to suicide and expressed interest in suicide prevention based on previous personal or professional experiences. Team members used template analysis for thematic analysis. ResultsStudy results focused specifically on program improvement; themes were divided between strengths of QPR training and opportunities for improvement. Results from this current study supported findings from previous studies including enhanced self-efficacy, the value of role-play, and the need for engaging presenters and relevant resources. Study findings add an important voice to the discussion: trainees who intervened in a suicidal crisis post-QPR training. ConclusionDespite its shorter duration, QPR Gatekeeper Training has been shown to be a highly effective program to prepare people to successfully intervene during a suicidal crisis. This study adds to the growing body of literature regarding QPR Gatekeeper Training efficacy and highlights the need for further study regarding program enhancements.

Examining Sex-Based Delays in Utilizing Advocacy Support Services Among Australian Military Veterans: Implications for Health Care Access and Suicide Prevention

This study explores the impact of sex on delays experienced by Australian military veterans in accessing advocacy support services within the veterans’ non-profit sector. A detailed analysis of intake records from 150 injured veterans who entered the Returned and Services League of Australia’s advocacy program in 2021 reveals significant disparities between male and female veterans in seeking assistance. On average, male veterans delay accessing support by 20.4 years post-service, compared to 9.1 years for female veterans. These prolonged delays hinder veterans’ ability to secure financial and medical support from the Department of Veterans’ Affairs, limiting timely access to essential healthcare services. As a result, delays can exacerbate physical and psychological symptoms, impede recovery, and increase the risk of suicide. The findings provide valuable insights for international healthcare professionals on the influence of military culture and traditional masculine norms in shaping veterans’ help-seeking behaviors. By understanding these dynamics, healthcare practitioners can develop targeted, sex-sensitive interventions that address specific barriers faced by male and female veterans. Ensuring timely access to advocacy support is crucial for improving health outcomes and reducing suicide risk in this vulnerable population.

A systematic review of the barriers associated with help-seeking among students at risk of suicide

ABSTRACT Suicide is one of the leading causes of death worldwide and post-secondary students are a particularly vulnerable group with respect to this. A systematic review was conducted to investigate the barriers associated with help-seeking for suicidality in this population, whilst exploring the quality of the literature. The databases PsychInfo, PsychArticles, MEDLINE, and Emcare were searched for publications up to the year 2022 inclusive, yielding ten publications. The most frequently cited barriers were lack of time and finance, questioning the seriousness of their own needs, wanting to deal with their problems on their own, perceiving stress to be a normal part of attending university/college, and perceived stigma. These barriers should be taken into consideration when designing suicide prevention strategies. Limitations of this review include the majority of studies within this review employing a cross-sectional design and only professional help-seeking. Future studies should employ longitudinal designs and investigate informal help-seeking.

Evaluating the Impact and Cultural Relevance of LifeKeepers Gatekeeper Training Across Three Training Modalities.

Background: While Gatekeeper Training (GKT) is an accepted component of suicide prevention strategies, there is little evidence about its effectiveness with Indigenous populations and online. Aims: This study examined the effects of LifeKeepers, a novel GKT, comprising three modalities: General, e-learning, and a culturally tailored Māori (New Zealand Indigenous) training. Methods: A total of 5,981 participants completed measures of declarative knowledge, perceived knowledge, and self-efficacy pre- and post-training. Participants rated satisfaction with LifeKeepers, its safety considerations and cultural acceptability post-training. Results: There were statistically significant improvements across all outcome measures (declarative knowledge 1.3 [95% CI 1.3-1.4], perceived knowledge 10.9 [95% CI 10.7-11.1], and self-efficacy 2.5 [95% CI 2.5-2.6]), including across all modalities. More than 90% of participants rated satisfaction, cultural acceptability, and safety considerations highly. Limitations: Without a control group, changes may not be solely due to engagement in LifeKeepers. Conclusions: This study offers preliminary evidence of the immediate effectiveness of LifeKeepers, across its in-person, Indigenous Māori, and e-learning modalities. It addresses a critical literature gap by exploring participants' safety perspectives and strongly supports LifeKeepers as a primary suicide prevention intervention in New Zealand, especially for Indigenous Māori communities. Comparable outcomes for e-learning participants indicate wider accessibility, bolstering suicide prevention efforts.

An Urgent Call for Suicide Prevention in Indonesia: The Clinicians’ Role in Preventing Suicide

Introduction: Since suicide is a complicated matter, multiple sectors must be involved. Globally, there were 703,000 suicide cases in 2019. Over the past three years, there has been a rise in suicide instances in Indonesia. Treating those who are at risk of suicide is difficult since suicide situations, like mental health illnesses, continue to carry stigma. To provide a statistical overview of suicide cases and the role of clinicians in preventing suicide cases. Methods: Searching for statistical data in Indonesia, we used Pubmed with the keyword “statistics”, “suicide”, “Indonesia”. Searching for data regarding risk factors and prevention of suicide, we also used Pubmed with the keywords “risk factor”, “prevention”, “screening”, “suicide”. Results: Globally, in 2019 the average rate of suicide cases was around 9.0 cases per 100,000 population. In Indonesia, exact data regarding the prevalence of suicide cases is still unknown. A person committing suicide can be caused by many factors such as previous mental disorders, relationship conflicts, legal problems, violence, financial problems, social exclusion, and low socioeconomic status. In addition to providing appropriate management, a clinician must provide education and outreach to the public regarding warning signs and risk factors for suicide, restrictions on tools for suicide, screening, and also remind every patient, especially patients with mental disorders, to continue to pray to be given health. Conclusion: A clinician has a role ranging from education and related outreach, screening, and also pharmacological and non-pharmacological management of someone at risk of suicide

Gabapentin and pregabalin exposures reported to United States poison centers, 2012–2022

BackgroundGabapentin and pregabalin were originally introduced as anticonvulsant medications but are now also prescribed on- and off-label for multiple medical disorders, especially for pain management. The national opioid crisis has led to increased use of non-opioid pain medications, including gabapentinoids, which has been associated with changing patterns of adverse events associated with these medications. This study investigated the characteristics and trends of gabapentin and pregabalin exposures reported to US poison centers from 2012 to 2022.MethodsNational Poison Data System data involving gabapentin and pregabalin exposures for 2012 to 2022 were analyzed.ResultsThere were 124,161 exposures involving gabapentin and pregabalin as the primary substance reported to US poison centers during the study period. Most exposures involved gabapentin (85.9%), females (59.4%), single-substance exposures (62.9%), or occurred at a residence (97.2%). Suspected suicides accounted for 45.2% of exposures. Most exposures were associated with a minor effect (27.4%) or no effect (34.0%), while 22.1% experienced a serious medical outcome, including 96 fatalities. The rate of gabapentin and pregabalin exposures per one million US population increased by 236.1% from 22.7 in 2012 to 76.5 in 2019 (P < 0.001), followed by a non-significant decrease to 68.5 in 2022 (P = 0.068).ConclusionsThe rate of gabapentin and pregabalin exposures reported to US poison centers increased by more than 230% from 2012 to 2019 before plateauing from 2019 to 2022. The observed rate trend was driven primarily by gabapentin exposures and by cases associated with suspected suicide. Although most exposures were associated with a minor or no effect, 22% of individuals experienced a serious medical outcome, including 96 fatalities. These findings contribute to the discussion of rescheduling gabapentin as a federally controlled substance, which is the current status of pregabalin. Prevention of suicide associated with gabapentin and pregabalin merits special attention.

Coming Up…

The International Association for Suicide Prevention is hosting the inaugural Pan‐American Conference Nov. 19‐22 in Minneapolis, Minn. For more information, visit https://www.iasp.info/minneapolis2024.

Communication dynamics and media interactions of young adults who have attempted suicide: a qualitative thematic analysis

ObjectiveThe study examines the potential effects of communication processes and media consumption habits on suicide ideation among male and female young adults aged 18–29 who have attempted suicide at least once.MethodsIn-depth interviews were analyzed using MAXQDA Analytics Pro 2024, and thematic analysis was applied according to Braun and Clarke’s model.ResultsFour themes emerged: (1) Family-related factors, (2) sociopsychological factors, (3) sociocultural factors, and (4) media-related factors. Regarding family-related factors, most participants come from broken family structures and commonly report issues with family communication and experiences of violence. Regarding sociopsychological factors, anger issues, despair, and addictions among participants were observed to increase suicide tendencies. Regarding sociocultural factors, most participants expressed difficulties in conforming to society and feeling pressures from cultural or religious expectations. Regarding media-related factors, it was noted that a vast majority of participants spend long hours consuming media daily and frequently interact with content that leads them into adverse emotional states, primarily for time passing on social media platforms.DiscussionThis research not only reinforces information in the literature but also presents unique findings compared to similar studies, particularly in cultural and geographical contexts. The results uniquely highlight the diversity in perceptions of the relationship between religion and suicide. While literature generally notes religion as a deterrent to suicide, this study reveals that intense religious pressure could increase suicidal tendencies through effects like rejection and hatred of religious values. Media also plays a reinforcing role in this context.ConclusionIn conclusion, this study elucidates the complex interactions underlying suicide attempts among young adults and provides a solid foundation for policies and interventions aimed at better managing media interactions, which play a critical role in suicide prevention efforts.

Characteristics and Circumstances of Suicide Among Children Aged 6 to 9 Years: 2006-2021.

Limited research exists on suicide among children aged 5 to 9 years. The objective of this study was to examine characteristics of suicide in children younger than 10 years. Data are from the National Fatality Review-Case Reporting System (NFR-CRS) for years 2006 through 2021 for children aged 6 to 9 years who died by suicide. No suicide deaths were reported in NFR-CRS for children aged ≤ 5 years. Descriptive analyses by demographics and circumstances were conducted. A thematic analysis of prevention recommendations made by child death review teams was performed. From 2006 to 2021, NFR-CRS identified 78 suicide decedents aged 6 to 9 years. The largest share were aged 9 years (72%), male (74%), non-Hispanic Black (42%), and died by hanging (86%) at home (91%). School-related problems (39%), history of child maltreatment (36%), history of mental health services (30%), argument with parents (23%), and familial discord (19%) were common circumstances. Key suicide prevention themes included education for caregivers and school staff, improved behavioral health services, and implementation of school policies and programs. Results provide a more complete picture of suicide among younger children, improving understanding of their unique characteristics. It is recommended that program planners consider both age-appropriateness and the impacts of social (eg, racism) and structural inequities in their approaches to prevention, encompassing both community and school-based strategies. For pediatricians, results emphasize the importance of lethal means counseling, safety planning, and educating parents and caregivers on the distinct warning signs of suicide for younger children.

Psychosocial characteristics of suicide deaths by regional types in Korea: An analysis based on population inflow and outflow.

This study aims to investigate the psychosocial characteristics of suicide deaths in Korea according to population inflow and outflow, and to identify high-risk suicide groups by regional type in order to establish tailored suicide prevention plans for each region. The analysis included 4193 suicide deaths from four regional types in Korea. The data source was a comprehensive survey of suicide deaths through police investigation records from the Korean government. The analysis involved collecting demographic variables, suicide-related variables, and stress variables at the time of death for suicide deaths in each region and conducting cross-analysis and multinomial logistic regression analysis. Across all regions, factors such as male gender, unemployment, hanging in one's own home, and mental health problems were prevalent. However, in population-inflow urban areas, early-middle age and economic problems were higher, in population-outflow urban areas, late-middle age and economic problems were more prominent. Additionally, in both inflow and outflow rural areas, there was a relatively higher proportion of old age and physical health problems. This study is significant for confirming common and specific factors influencing suicide in each region, and for proposing considerations when formulating tailored suicide prevention plans for local communities.