Suicide Prevention Tool Research Articles

Accessibility and Utility of an Electronic Self-Guided Safety Plan for Adolescents

ABSTRACT Objective Suicidal thoughts and behaviors are a leading cause of death, injury, and hospitalization among adolescents. Few evidence-based interventions exist, and these tend to be inaccessible for most youth. Electronic safety plan interventions represent a new avenue to disseminate an evidence-based suicide prevention tool. However, it is not clear whether youth find electronic, self-guided safety plans helpful, nor whether they will use the resulting safety card when experiencing suicidal thoughts or urges. This study examines adolescents’ perceptions and use of an electronic, self-guided safety plan intervention. Method We recruited 322 adolescents with a past-year history of suicidal thoughts or behaviors, ages 13–17 (55.9% white and non-Hispanic; majority reporting diverse sexual orientations and genders) online via social media to participate in this two-part longitudinal study. At baseline, participants completed the electronic safety plan interventions and reported on key aspects of its usefulness and areas of improvement. Participants reported their use and perceptions of the plan one month later. Results Results suggested that adolescents understood, liked, and believed they would use a self-guided safety plan. One month later, about ⅓ of youth who experienced suicidal thoughts or urges used their safety card. Open-ended responses highlighted several features that adolescents enjoyed, including clarity, ease of use, and privacy. Participants also highlighted key areas for improvement, including formatting and language. Conclusion This study provides initial support for adolescent use of electronic self-guided safety plans. Next steps include updating this intervention based on youth feedback and testing the effectiveness of this tool using gold standard research methods.

Suicidality and Intellectual Disability: A Systematic Review

ABSTRACT Background Suicidality in individuals with intellectual disability is a critical but under-researched area. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and interventions for suicidality among individuals with intellectual disability. Methods Adhering to the PRISMA guidelines, a comprehensive review of databases was conducted for empirical studies on suicidality in intellectual disability. Data were extracted on sample characteristics, methodologies, and key findings. Results Nineteen studies met the inclusion criteria. Consistent risk factors, notably comorbid psychiatric disorders, emerged. Passive suicide methods predominated with a positive correlation between higher intellectual functioning and increased suicidal behaviors. Conclusions The increased vulnerability to suicide in this population highlights the need for targeted interventions and comprehensive risk assessments. Much future research is required in the face of paucity of data with the priority on developing specific suicide prevention tools while addressing cultural stigmas to enhance support for this population.

Suicide Prevention Effects of Extreme Risk Protection Order Laws in Four States.

More than half of suicide deaths in the United States result from self-inflicted firearm injuries. Extreme risk protection order (ERPO) laws in 21 states and the District of Columbia temporarily limit access to firearms for individuals found in a civil court process to pose an imminent risk of harm to themselves or others. Research with large multistate study populations has been lacking to determine effectiveness of these laws. This study assembled records pertaining to 4,583 ERPO respondents in California, Connecticut, Maryland, and Washington. Matched records identified suicide decedents and self-injury method. Researchers applied case fatality rates for each suicide method to estimate nonfatal suicide attempts corresponding to observed deaths. Comparison of counterfactual to observed data patterns yielded estimates of the number of lives saved and number of ERPOs needed to avert one suicide. Estimates varied depending on the assumed probability that a gun owner who attempts suicide will use a gun. Two evidence-based approaches yielded estimates of 17 and 23 ERPOs needed to prevent one suicide. For the subset of 2,850 ERPO respondents with documented suicide concern, comparable estimates were 13 and 18, respectively. This study's findings add to growing evidence that ERPOs can be an effective and important suicide prevention tool.

Substitution of Methods in Suicide Deaths - Firearm Injury and Hanging.

Background: Prevention strategies for suicide emphasize restrictions on firearm access. These restrictions may lose efficacy if individuals substitute other lethal suicide methods. Aims: The objective of this study is to determine the extent to which individuals who die by suicide in the United States substitute hanging for firearm injury. Methods: This study is a repeated cross-sectional analysis of suicide deaths in the United States from 2003 to 2021. Multiple regression was used to estimate the effect of firearm access proxies on individual suicide methods (hanging vs. firearm injury). Results: The probability of death by hanging was significantly and negatively associated with proxies of firearm access. Limitations: This study does not compare crude rates of suicide by state, which rise on average with rates of firearm ownership. The National Violent Death Reporting System expanded over the sample period, so early years have incomplete ascertainment. Rates of gun ownership and gun safety law scales are measured as proxies. Conclusions: Although means restriction around firearm access is a critical tool for suicide prevention, complementary strategies for prevention around hanging merit further study.

The Associations between the Number of School Sports Teams That a Student Regularly Participates in and Factors Such as Perceived Stress, Loneliness, and Sleep Satisfaction among Korean Adolescents Who Have Attempted Suicide.

Adolescents who have attempted suicide are more likely to experience a recurrence of suicidal behavior, thus necessitating systematic follow-ups and management. We aimed to investigate the association between the number of school sports teams that a student regularly participates in and psychological factors such as perceived stress, loneliness, and sleep satisfaction among 1393 Korean adolescents who have attempted suicide by using data from the 2022 Korea Youth Risk Behavior Survey. Frequency analyses were performed to evaluate participant characteristics. Chi-square analyses were used to examine the differences in participant characteristics according to the number of teams. Multivariate logistic regression analysis was used to examine the associations between the number of teams and perceived stress, loneliness, and sleep satisfaction. Our results indicated that participating in a greater number of sports teams at school was more strongly associated with reduced perceived stress, reduced loneliness, and increased sleep satisfaction. Specifically, the odds ratio (OR) for feeling very much stressed was 0.613 (range: 0.387-0.969; p = 0.036) among the participants who belonged to one team. Among those who belonged to two teams, the OR for feeling very much stressed was 0.482 (range: 0.281-0.286; p = 0.008). Among those who belonged to two teams, the OR for feeling a lot of stress was 0.514 (range: 0.304-0.870; p = 0.013), and that for not feeling much stress was 2.663 (range: 1.103-6.426; p = 0.029). The OR for not feeling much stress was 4.697 for those who belonged to three teams (range: 1.531-14.408; p = 0.007) and 6.671 for those who belonged to four or more teams (range: 1.858-23.953; p = 0.004). The OR for feeling no stress at all was 11.629 (range: 2.229-60.661; p = 0.004) for those who belonged to three teams and 93.531 (range: 19.260-454.207; p < 0.001) for those who belonged to four or more teams. In terms of loneliness, the OR for rarely feeling lonely was 2.651 (range: 1.148-6.123; p = 0.022) among those who belonged to one team. The OR for feeling lonely all the time was 0.370 (range: 0.155-0.884; p = 0.025) among those who belonged to two teams. In terms of sleep satisfaction, the OR for having very sufficient sleep was 4.371 (range: 1.627-11.742; p = 0.003) for those who belonged to four or more teams. These results suggest that school sports are an advantageous tool for suicide prevention, given their low costs, absence of side effects, and ease of participation.

Perceptions of the utility of secure firearm storage methods as a suicide prevention tool among firearm owners who currently store their firearms loaded and unlocked.

Although secure firearm storage can prevent firearm injury and death, secure storage is relatively rare. This tendency may be driven in part by a perceived lack of utility for secure storage in preventing suicide and other gun violence-related outcomes. We recruited a large (n = 3510) representative sample of residents from five US states and assessed the degree to which those who do and do not store their firearms securely perceive different utility in specific firearm storage practices for suicide prevention. To test for specificity, we examined if those differences hold when considering unintentional shooting and firearm theft prevention. Those who currently store their firearms unsecured reported lower perceived utility in several firearm storage practices, particularly for suicide and theft prevention. Our findings highlight that a lack of perceived utility in secure firearm storage may partially drive unsecure firearm storage. Efforts to promote secure storage must address this misperception.

Suicide Risk Assessment and Prevention Tools in the UK: Current Landscape and Future Directions

Suicide is a major global public health problem, with profound implications for individuals, families, and communities. In the United Kingdom (UK), despite efforts to detect and manage suicidal ideas, suicide rates persist, especially among middle-aged men and women, particularly those aged 45 to 54 years. Recent global challenges, such as the COVID-19 pandemic, climate change, conflict, and the environmental crisis, have raised concerns about an increase in suicide rates, particularly among young people. As a result, a population-wide preventive approach based on evidence is imperative to mitigate the projected increase in suicides. To evaluate the effectiveness of suicide prevention strategies, there is a need for an objective and universally accepted risk assessment approach that does not currently exist. This review examines the current landscape of suicide prevention in the United Kingdom and evaluates the strengths and limitations of existing suicide risk assessments tools. The current suicide prevention tools used, including machine learning and mobile applications are discussed. Also, the epidemiological trends in the various regions of the UK, risk factors including age, sex, and socio-economic status are assessed to provide context. Through this discourse, we hope to provide valuable insight for clinicians, researchers, and policy makers about the current landscape of suicide, especially within the United Kingdom, while presenting recommendations regarding areas that require further research and improvement. Accordingly, suicide prevention is and will continue to be a major focus of both the national health service and research in the UK in the strive to reduce the rate of suicide across all regions. Indeed, headways have been made in the use of technology in preventing suicide both locally and globally. However, research should in the future investigate the value of personalized interventions tailored to the various risk factors of suicide and based on appropriate screening and assessment tools.

Developing Suicide Prevention Tools in the Context of Digital Peer Support: Qualitative Analysis of a Workshop With Multidisciplinary Stakeholders.

Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. A full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. Participants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) "progress" is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians.

Codesign of a digital health tool for suicide prevention: protocol for a scoping review

IntroductionThe role of digital health in providing psychological treatment and support for the prevention of suicide is well documented. Particular emphasis has been placed on digital health technologies during the...

Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial

BackgroundSuicide prevention is a national priority for the UK government. Autistic people are at greater risk of experiencing self-harm and suicidal thoughts and behaviours than the general population. Safety plans are widely used in suicide prevention but have not yet been designed with and for autistic people. We developed the first safety plan specifically targeting suicidality in autistic adults: the Autism Adapted Safety Plan (AASP). It consists of a prioritised list of hierarchical steps that can be used prior to or during a crisis to mitigate risk of self-harm and suicidal behaviour. This is a pilot study that aims to assess the feasibility and acceptability of the AASPs and the research processes, including the response rates, potential barriers and reach of AASPs, methods of recruitment, what comprises usual care, and economic evaluation methods/tools.MethodsThis is an external pilot randomised controlled trial of a suicide prevention tool aimed at mitigating the risk of self-harm and suicidal behaviour in autistic adults: AASPs. Participants will be assessed at baseline and followed up 1 month and 6 months later. Assessments include questions about self-harm, suicidality, service use, and their experience of the AASP/taking part in the study. Autistic adults who have a clinical autism diagnosis and self-reported history of self-harm, suicidal thoughts, or suicidal behaviours within the last 6 months will be invited to take part in the study. Informed consent will be obtained. Participants will be recruited via community and third sector services (including community settings, autism charities, and mental health charities). They may also “self-refer” into the study through social media recruitment and word of mouth. Ninety participants will be randomised to either develop an AASP or receive their usual care in a 1:1 ratio.DiscussionThe present study will provide an evaluation of the suitability of the processes that would be undertaken in a larger definitive study, including recruitment, randomisation, methods, questionnaires, outcome measures, treatment, and follow-up assessments.Trial registrationISRCTN70594445, Protocol v4: 8/2/22.

Poor self-reported sleep quality associated with suicide risk in a community sample of American Indian adults

Abstract Study Objectives Although American Indian/Alaska Native (AI/AN) have high suicide rates few studies have systematically investigated sleep quality and its association with suicidal behaviors in AI/AN. This study is a cross-sectional investigation of self-reported sleep quality and suicidal behaviors in an adult AI population. Methods A semi-structured interview was used to collect data on suicidal ideation, suicidal plans, and suicidal attempts and the Pittsburgh Sleep Quality Index (PSQI) was collected to assess sleep quality in American Indian adults. Results In this sample (n = 477), 91 (19%) of the participants endorsed suicidal ideation (thoughts and plans), and 66 (14%) reported suicidal attempts, including four who subsequently died by suicide. More women reported suicidal thoughts or acts than men. Those endorsing suicidal thoughts slept fewer hours during the night, reported more nocturnal awakenings, and showed poorer subjective sleep quality according to PSQI total scores compared to those with no suicidal thoughts or acts. Participants with suicidal acts (n = 66) reported more bad dreams and higher PSQI total scores compared to those with no suicidal thoughts or acts. When those with any suicidal thoughts or acts (n = 157, 33%) were compared to those without, they were more likely to endorse nocturnal awakenings and bad dreams and demonstrated significantly higher PSQI total scores. Conclusions Although additional research is needed to evaluate sleep disturbances as a proximal, causal risk factor for suicidal behaviors in AI, findings highlight need for further study of sleep as a warning sign and intervention tool for suicide prevention among American Indian adults.

The mental health and suicide prevention training module of the French sanitary service: Effectiveness on health students

AbstractSince 2018, a Sanitary Service for Health Students (SSHS) is being implemented throughout France. All French health students must complete their SSHS choosing one of the modules proposed by their institution to be trained to the principles of prevention and then bring them to carry out prevention and health promotion actions in their respective region. A controlled pre/postdesign was conducted to assess the impact of the Mental Health and Suicide Prevention (MHSP) training module on health students. Students assigned to this module were considered as exposed, and students assigned to any other module as unexposed. Health students from the Nord‐Pas‐de‐Calais region involved in the SSHS during the school year 2018–2019 were asked to answer a self‐administered questionnaire before (September 2018), and after completing their SSHS (May 2019). A total of 144 matched participants (48 in the exposed group and 96 in the unexposed group) were analyzed. When comparing the exposed group to the unexposed group, satisfaction with the training was greater (4.7 vs. 3.6 out of 5, p &lt; 0.001), self‐confidence in professional capacities improved (+1.8 vs. −0.2, p = 0.038), students were more likely to report having identified (68% vs. 48%, p = 0.043) or helped (66% vs. 18%, p &lt; 0.001) someone, as well as having consulted for a mental health issue (13% vs. 4%, p = 0.008). In conclusion, the MHSP training module improves health students' confidence in their professional abilities to help distressed people, promotes supportive behaviors of health students, and reinforces their help‐seeking behaviors. It could be a useful tool for suicide prevention.

"Lock to Live" for firearm and medication safety: Feasibility and acceptability of a suicide prevention tool in a learning healthcare system.

ObjectiveFew patients with suicide risk are counseled on lethal means safety by health providers. This study tested the feasibility of different delivery methods for Lock to Live (L2L), a web-based decision aid of safe storage options for firearms and medications.MethodsPatients reporting suicide ideation on the PHQ9 depression screener during outpatient health visits were included. Invitation messages to visit L2L were sent via combinations of email, text, Electronic Health Record (EHR) message, mailed letter, or provider referral, followed by a survey about storage behavior and acceptability. Provider interviews evaluated logistical considerations and acceptability.ResultsThe population-based method reached 2,729 patients and the best method (EHR message plus 2 email reminders) had 11% uptake (L2L visitation rate). Provider referral had small reach (14 patients) and 100% uptake (all visited). Provider interviews identified several strategies to promote uptake including: EHR reminders, provider training, quality metrics with accountability, a clearly communicated lethal means screening/counseling policy, and strong organizational leadership support.ConclusionDespite the low uptake for population-based (11%), far more patients with suicide risk were engaged in the L2L tool through population-based outreach than provider-referral over the same time frame.

Acceptability and satisfaction with emma, a smartphone application dedicated to suicide ecological assessment and prevention.

BackgroundAs mHealth may contribute to suicide prevention, we developed emma, an application using Ecological Momentary Assessment and Intervention (EMA/EMI).ObjectiveThis study evaluated emma usage rate and acceptability during the first month and satisfaction after 1 and 6 months of use.MethodsNinety-nine patients at high risk of suicide used emma for 6 months. The acceptability and usage rate of the EMA and EMI modules were monitored during the first month. Satisfaction was assessed by questions in the monthly EMA (Likert scale from 0 to 10) and the Mobile App Rating Scale (MARS; score: 0–5) completed at month 6. After inclusion, three follow-up visits (months 1, 3, and 6) took place.ResultsSeventy-five patients completed at least one of the proposed EMAs. Completion rates were lower for the daily than weekly EMAs (60 and 82%, respectively). The daily completion rates varied according to the question position in the questionnaire (lower for the last questions, LRT = 604.26, df = 1, p-value < 0.0001). Completion rates for the daily EMA were higher in patients with suicidal ideation and/or depression than in those without. The most used EMI was the emergency call module (n = 12). Many users said that they would recommend this application (mean satisfaction score of 6.92 ± 2.78) and the MARS score at month 6 was relatively high (overall rating: 3.3 ± 0.87).ConclusionEmma can target and involve patients at high risk of suicide. Given the promising users’ satisfaction level, emma could rapidly evolve into a complementary tool for suicide prevention.

精神不調アセスメントツール（RAMPS）を活用した高校生の自殺予防の実践例:―新潟県内高等学校養護教諭へのインタビュー調査から

精神不調アセスメントツール（RAMPS）を活用した高校生の自殺予防の実践例:―新潟県内高等学校養護教諭へのインタビュー調査から

Factors associated with suicidal ideation in an epilepsy center in Northern New England

Suicidal ideation (SI), defined as thoughts and feelings of ending one’s life, is a known risk factor for completed suicide. Although studies show that rates of SI are elevated in persons with epilepsy (PWE) compared to the general population, it is presently unclear how disease, social, and psychological factors contribute to its frequency and severity. With an overarching goal to develop a screening tool for suicide prevention, the objective of this study was to understand the rate, severity, and factors associated with SI in a large cohort of PWE.A generalized linear mixed model was used to test the relationship between changes in SI and disease, social, and psychological variables in 2450 PWE over a period of four years. The prevalence of SI was 23.6%. Associated disease factors included increased seizure frequency, severity, and recency. SI was impacted by employment status, but not by driving. Depression scores and aggression were highly associated with frequency and severity of SI. These findings highlight that disease, social, and psychological factors impact levels of SI in PWE and that screening for suicide prevention in PWE should include measures of such factors.

Adaptation of a french e-health tool for suicide prevention in young populations: Modalities and benefits

IntroductionFrance’s suicide rate is among the highest in Europe, with the young among the more at risk than others. Several European projects have demonstrated the effectiveness of using e-tools in suicide prevention particularly for hard-to-reach populations. Lessons from StopBlues, an e-health tool (application/website) for suicide prevention in the general population developed in 2018 which was promoted by municipalities and general practitioners, shows the necessity to adapt its content for young people.ObjectivesThe objective is to develop an e-health tool, BlueZberry, for suicide prevention targeting adolescents and young adults with psychological pain by adapting StopBlues and its promotional plan.MethodsThe detailed content of BlueZberry and its promotional plan were determined via a literature review and 26 individual and group interviews with experts and youth with StopBlues as a starting part.ResultsThe literature review and interviews confirmed the need to adapt the tool according to age of the user since the context and source of psychological pain vary rapidly at this time of life. BlueZberry consists of three modules for age groups 12-14, 15-17 and 18-25 years with specific graphics and messages. Its locally organized promotion should include youth hangouts on top of usual places.ConclusionsThis adaptation of StopBlues will reach a larger audience by offering a more suitable solution for this vulnerable population. A web-portal will serve as an entry point for both StopBlues and BlueZberry where users will be redirected to one of the tools/modules according to their profile and respective needs.

Suicide after Facebook posts–An unnoticed departure of life in Bangladesh

Social networking sites have changed the concept of social interaction and communication. There is increasing evidence of using Facebook to express suicidal ideas and feelings, predominantly among young people. Here, we report a series of cases where victims committed suicide after sharing their thoughts and feelings on Facebook posts or live-streaming. In the present case series, we observed most of the victims were teenagers and young adults. Usually, this group is unwilling to share their suicidal thoughts with physicians or other family members. At the same time, they like to share those factors on Facebook or other social networking sites. So, Facebook can be a potential tool to predict and prevent such suicide cases. A better understanding and quick response to suicidal notes on Facebook can prevent many lives. The present study suggests ensuring the active participation of Facebook users in suicide prevention programs. We can work together with suicide prevention tools and strategies of social networking sites to save many unwanted departures.

The development and evaluation of an evidence-based suicide prevention strategy in Flanders (Belgium)

Abstract Background Suicide rates in Belgium have been consistently high, with a current prevalence of 15.1 suicides per 100.000 inhabitants, which is 1.5 times higher than the European average. In Flanders (northern part of Belgium) more than 10.000 suicide attempts are being registered every year and studies show that 13 % of the population reports a lifetime history of suicidal thoughts. Since 2006 an extensive Suicide Prevention Strategy has been implemented in Flanders, aiming to decrease the Flemish suicide rate by 20% by 2020 (baseline year 2000). Methods The Suicide Prevention Strategy has been developed by a team of experts, involving multiple stakeholders and the lay public. The 'Flemish Centre of Expertise in Suicide Prevention' (VLESP) was launched by the government to coordinate and monitor the prevention campaigns, tools and interventions included in the strategy, and to study their effectiveness. Results The Suicide Prevention Strategy includes five key strategies namely: 1) mental health promotion, 2) providing helplines and online help, 3) educating health professionals and community facilitators, 4) developing programs targeting high risk groups, 5) developing and implementing targeted suicide prevention guidelines for health professionals and other key gatekeepers. A range of innovative suicide prevention tools and interventions, such as an e-learning course for health professionals, smartphone applications and group therapies for suicidal individuals, have been developed and positively evaluated. In 2017 (in comparison with the year 2000) suicide rates in men decreased with 27% and suicide rates in women with 26%. For suicide attempts, a decrease of 19% was noted. Conclusions Suicide prevention is a public health priority in Flanders. A combination of evidence-based tools and interventions have been developed and assessed in the past years, resulting in a decrease in suicide rates.

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

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