International Journal of Environmental Research and Public Health

Research

16 pages, 502 KiB

Open AccessArticle

Understanding the Experience and Needs of School Counsellors When Working with Young People Who Engage in Self-Harm

by Ben Te Maro, Sasha Cuthbert, Mia Sofo, Kahn Tasker, Linda Bowden, Liesje Donkin and Sarah E. Hetrick

Int. J. Environ. Res. Public Health 2019, 16(23), 4844; https://doi.org/10.3390/ijerph16234844 - 02 Dec 2019

Cited by 5 | Viewed by 3426

Abstract

Self-harm rates are increasing globally and demand for supporting, treating and managing young people who engage in self-harm often falls to schools. Yet the approach taken by schools varies. This study aimed to explore the experience of school staff managing self-harm, and to [...] Read more.

Self-harm rates are increasing globally and demand for supporting, treating and managing young people who engage in self-harm often falls to schools. Yet the approach taken by schools varies. This study aimed to explore the experience of school staff managing self-harm, and to obtain their views on the use of guidelines in their work. Twenty-six pastoral care staff from New Zealand were interviewed. Interviews were analyzed and coded using thematic analysis. Three themes emerged: The burden of the role; discrepancies in expectations, training, and experience; and the need for guidelines to support their work. This research, therefore, demonstrated a need for guidelines to support school staff to provide support around decision making and response to self-harm in the school environment. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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11 pages, 688 KiB

Open AccessArticle

Adapting Digital Social Prescribing for Suicide Bereavement Support: The Findings of a Consultation Exercise to Explore the Acceptability of Implementing Digital Social Prescribing within an Existing Postvention Service

by Karen Galway, Trisha Forbes, Sharon Mallon, Olinda Santin, Paul Best, Jennifer Neff, Gerry Leavey and Alexandra Pitman

Int. J. Environ. Res. Public Health 2019, 16(22), 4561; https://doi.org/10.3390/ijerph16224561 - 18 Nov 2019

Cited by 3 | Viewed by 3646

Abstract

This paper describes a consultation exercise to explore the acceptability of adapting digital social prescribing (DSP) for suicide bereavement support. Bereavement by suicide increases the risk of suicide and mental health issues. Social prescribing improves connectedness and empowerment and can provide digital outcomes-based [...] Read more.

This paper describes a consultation exercise to explore the acceptability of adapting digital social prescribing (DSP) for suicide bereavement support. Bereavement by suicide increases the risk of suicide and mental health issues. Social prescribing improves connectedness and empowerment and can provide digital outcomes-based reporting to improve the capacity for measuring the effectiveness of interventions. Our aim was to consult on the acceptability and potential value of DSP for addressing the complexities of suicide bereavement support. Our approach was underpinned by implementation science and a co-design ethos. We reviewed the literature and delivered DSP demonstrations as part of our engagement process with commissioners and service providers (marrying evidence and context) and identified key roles for stakeholders (facilitation). Stakeholders contributed to a co-designed workshop to establish consensus on the challenges of providing postvention support. We present findings on eight priority challenges, as well as roles and outcomes for testing the feasibility of DSP for support after suicide. There was a consensus that DSP could potentially improve access, reach, and monitoring of care and support. Stakeholders also recognised the potential for DSP to contribute substantially to the evidence base for postvention support. In conclusion, the consultation exercise identified challenges to facilitating DSP for support after suicide and parameters for feasibility testing to progress to the evaluation of this innovative approach to postvention. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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12 pages, 313 KiB

Open AccessArticle

The Attempt Was My Own! Suicide Attempt Survivors Respond to an Australian Community-Based Suicide Exposure Survey

by Myfanwy Maple, Kathy McKay and Rebecca Sanford

Int. J. Environ. Res. Public Health 2019, 16(22), 4549; https://doi.org/10.3390/ijerph16224549 - 18 Nov 2019

Cited by 6 | Viewed by 4027

Abstract

Those who attempt suicide have often been overlooked in the suicide prevention literature. Where stories of lived experience have been included, it is often from the perspectives of healthcare professionals who treat the physical and/or psychological impacts following an attempt, rather than firsthand [...] Read more.

Those who attempt suicide have often been overlooked in the suicide prevention literature. Where stories of lived experience have been included, it is often from the perspectives of healthcare professionals who treat the physical and/or psychological impacts following an attempt, rather than firsthand accounts. Yet, the most intimate insights of suicide are lost by not including the voices of those with lived experience of suicide attempt. Through an online, community-based, non-representative survey exploring the impact of exposure to suicide, a sub-sample of 88 participants responded who reported their exposure to suicide as being their own attempt. The survey covered demographic information, questions assessing exposure to suicide attempts and death, current global psychological distress via the Kessler Psychological Distress (K10) Scale, and short qualitative responses provided by 46 participants. The qualitative data was thematically analysed resulting in three themes; the way in which individuals experienced being suicidal; who they were able, or not, to disclose these intentions to—before and after their suicide attempt; and, how these people experienced the formal and informal health care supports available to them to assist with their suicidal crisis. This paper presents important findings from a sample of participants who are highly distressed, and have previously attempted to take their own lives. This adds depth to our understanding of lived experience of suicide attempt, issues associated with seeking appropriate support after suicide attempt, and also demonstrates a willingness of participants to share their stories, even in a study that did not explicitly target those with lived experience of suicide attempt. The need for consistent and compassionate mental health care after a suicide attempt is identified as a vital component of living well after a suicide attempt. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

24 pages, 380 KiB

Open AccessArticle

Putting Suicide Policy through the Wringer: Perspectives of Military Members Who Attempted to Kill Themselves

by Tirzah Parrish LeFeber and Bernadette Solorzano

Int. J. Environ. Res. Public Health 2019, 16(21), 4274; https://doi.org/10.3390/ijerph16214274 - 04 Nov 2019

Cited by 6 | Viewed by 3476

Abstract

In response to the Air Force Surgeon General, Lieutenant General Mark Ediger’s call for medical services to be guided by service members’ values, preferences, and experiences within the medical system, we conducted an interpretive phenomenological analysis of transcripts in which service members shared [...] Read more.

In response to the Air Force Surgeon General, Lieutenant General Mark Ediger’s call for medical services to be guided by service members’ values, preferences, and experiences within the medical system, we conducted an interpretive phenomenological analysis of transcripts in which service members shared their experiences of military mental health policy and practices after being identified as suicidal. Themes of their experiences underscore nuances as it relates to intersectionality of policy when faced with unique military contextual factors and power differentials; both of which were missing in available research literature. Their experiences also illuminate further the innate “Catch 22” which happens when accessing help. Catch 22 basically means if you know you need help than you are rational; but if you actually seek help, then you are crazy and not trustworthy to do your job. Themes presented center on the lack of confidentiality of Service Members in the Workplace, effects of Unit Members’ Surveillance and Command Directed Evaluations, and experiences of Military Mental Health Services. Critical discussions of policy and taken for granted assumptions that often drive narrow responses to suicide, treatment, prevention, and stigma are presented. Particular attention is given to the lived experiences of service members when placed under the demands of circumstances created by policy that may inadvertently lead in some cases to further suffering. The paper closes with recommendations from participants and the authors for policy makers and future directions in research. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

12 pages, 309 KiB

Open AccessArticle

Use of Alcohol and Unprescribed Drugs after Suicide Bereavement: Qualitative Study

by Jessica Eng, Lauren Drabwell, Fiona Stevenson, Michael King, David Osborn and Alexandra Pitman

Int. J. Environ. Res. Public Health 2019, 16(21), 4093; https://doi.org/10.3390/ijerph16214093 - 24 Oct 2019

Cited by 13 | Viewed by 4057

Abstract

Studies describing the impact of suicide bereavement report an excess risk of suicide, suicide attempt, psychiatric illness, and drug and alcohol use disorders compared with the general population. However, the nature of patterns of drug and alcohol use after suicide bereavement is unclear. [...] Read more.

Studies describing the impact of suicide bereavement report an excess risk of suicide, suicide attempt, psychiatric illness, and drug and alcohol use disorders compared with the general population. However, the nature of patterns of drug and alcohol use after suicide bereavement is unclear. We used an online survey to collect qualitative data to understand whether and how drug and alcohol use changes after suicide bereavement. We conducted thematic analysis of free-text responses to a question capturing their use of alcohol and drugs after the suicide of a family member or a close friend. Analysing data from 346 adults in Britain aged 18–40, we identified three main themes describing the relationship of suicide bereavement to alcohol or drug use: (1) control over drug or alcohol use, (2) the perceived purpose of using drugs or alcohol, and (3) the attribution of drug or alcohol misuse to external factors. Overlying these themes were dimensions of control and of awareness of potential harms. This study highlights that increased use of drugs and alcohol after suicide bereavement may form part of a bereaved person’s coping strategies, and that sensitive approaches are needed when judging whether and when to intervene. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

13 pages, 290 KiB

Open AccessArticle

Lived Experiences of Suicide Risk and Resilience among Alaska Native and American Indian People

by Jennifer L. Shaw, Julie A. Beans, Katherine Anne Comtois and Vanessa Y. Hiratsuka

Int. J. Environ. Res. Public Health 2019, 16(20), 3953; https://doi.org/10.3390/ijerph16203953 - 17 Oct 2019

Cited by 19 | Viewed by 4350

Abstract

This study explored the lived experiences of suicidality and help-seeking for suicide prevention among Alaska Native and American Indian (AN/AI) people in a tribal health system. An interpretive phenomenological approach was used to analyze semi-structured, in-depth interviews with 15 individuals (ages 15–56) with [...] Read more.

This study explored the lived experiences of suicidality and help-seeking for suicide prevention among Alaska Native and American Indian (AN/AI) people in a tribal health system. An interpretive phenomenological approach was used to analyze semi-structured, in-depth interviews with 15 individuals (ages 15–56) with self-reported histories of suicide ideation and/or attempt. Several factors were found to be central to acquiring resilience to suicide risk among AN/AI people across a wide age range: meaningful and consistent social connection, awareness about how one’s suicide would negatively effect loved ones, and knowledge and utilization of available health services. Findings highlight the mutable nature of suicide risk and resilience, as well as the importance of interpersonal factors in suicidality. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

14 pages, 314 KiB

Open AccessArticle

Recipients of Suicide-Related Disclosure: The Link between Disclosure and Posttraumatic Growth for Suicide Attempt Survivors

by Laura M. Frey, Christopher W. Drapeau, Anthony Fulginiti, Nathalie Oexle, Dese’Rae L. Stage, Lindsay Sheehan, Julie Cerel and Melinda Moore

Int. J. Environ. Res. Public Health 2019, 16(20), 3815; https://doi.org/10.3390/ijerph16203815 - 10 Oct 2019

Cited by 9 | Viewed by 3339

Abstract

It is important to explore factors that could help or hinder one’s wellbeing following a suicide attempt, which could yield not only negative consequences but also posttraumatic growth (PTG; positive changes following a traumatic event). The present study used a multivariate analysis of [...] Read more.

It is important to explore factors that could help or hinder one’s wellbeing following a suicide attempt, which could yield not only negative consequences but also posttraumatic growth (PTG; positive changes following a traumatic event). The present study used a multivariate analysis of covariance (MANCOVA) to test the relationship between disclosure, PTG, and posttraumatic depreciation among suicide attempt survivors when controlling for time since attempt and to test whether these effects remained after controlling for quality of support from family and friends. Suicide attempt survivors (n = 159) completed an online survey about their experiences. Increases in disclosure to family and friends but not to healthcare providers predicted changes in PTG. The effects of family disclosure remained even after controlling for quality of support. Disclosure to healthcare providers demonstrated some statistical effects on PTG, yet in the opposite direction and only after controlling for quality of support. The control variables—time since attempt and quality of support—were the only variables that predicted a change in posttraumatic depreciation. These findings suggest there is value in disclosing one’s personal story to family regardless of whether one receives supportive responses and that social support can impact one’s PTG. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

13 pages, 913 KiB

Open AccessArticle

“Let’s Talk About It”: The Moderating Role of Self-Disclosure on Complicated Grief over Time among Suicide Survivors

by Yossi Levi-Belz and Lilac Lev-Ari

Int. J. Environ. Res. Public Health 2019, 16(19), 3740; https://doi.org/10.3390/ijerph16193740 - 04 Oct 2019

Cited by 29 | Viewed by 4028

Abstract

Suicide often imparts highly stressful ramifications to those left behind. Previous research on suicide survivors (SUSs) has demonstrated their being at high risk for developing anxiety and depression, including pathological complicated grief (CG). Self-disclosure (S-D)––the tendency to share one’s personal feelings––has been found [...] Read more.

Suicide often imparts highly stressful ramifications to those left behind. Previous research on suicide survivors (SUSs) has demonstrated their being at high risk for developing anxiety and depression, including pathological complicated grief (CG). Self-disclosure (S-D)––the tendency to share one’s personal feelings––has been found to be an important component of dealing with grief. In this study, we examined the effect of S-D on CG in an 18-month longitudinal design following one hundred fifty-six SUSs. We found that SUSs suffering from pathological CG at Time 1 (T1) were lower in S-D at T1 and T2 and higher in depression at T2. We also found that SUSs with lower S-D at T1 had higher CG at T2. Using a structural equation model, we found that S-D at T1 contributed significantly (and negatively) to CG at T1, above and beyond the natural fading of CG over time. Our findings emphasize that while CG is highly prevalent among SUSs, S-D has a beneficial effect which can serve as a protective factor against CG for this group. Implications regarding possible interventions with SUSs were discussed. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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17 pages, 2153 KiB

Open AccessArticle

Our Healthy Clarence: A Community-Driven Wellbeing Initiative

by Nicholas Powell, Hazel Dalton, David Perkins, Robyn Considine, Sue Hughes, Samantha Osborne and Richard Buss

Int. J. Environ. Res. Public Health 2019, 16(19), 3691; https://doi.org/10.3390/ijerph16193691 - 30 Sep 2019

Cited by 11 | Viewed by 5306

Abstract

In 2015–2016, the Clarence Valley in Northern New South Wales, Australia, experienced an unexpectedly high number of deaths by suicide, and the resulting distress was exacerbated by unhelpful press coverage. The local response was to adopt a community-wide positive mental health and wellbeing [...] Read more.

In 2015–2016, the Clarence Valley in Northern New South Wales, Australia, experienced an unexpectedly high number of deaths by suicide, and the resulting distress was exacerbated by unhelpful press coverage. The local response was to adopt a community-wide positive mental health and wellbeing initiative. This paper describes the process and achievements of the initiative called ‘Our Healthy Clarence’. Key stakeholders were interviewed at year two and relevant documents reviewed. Data were analysed using document and thematic analysis. Our Healthy Clarence was established following community consultation, including forums, interviews, surveys and workshops. It adopted a strengths-based approach to suicide prevention, encompassing positive health promotion, primary and secondary prevention activities, advocacy, and cross-sectoral collaboration. A stakeholder group formed to develop and enact a community mental health and wellbeing plan. Factors contributing to its successful implementation included a collective commitment to mental health and wellbeing, clarity of purpose, leadership support from key local partners, a paid independent coordinator, and inclusive and transparent governance. Stakeholders reported increased community agency, collaboration, optimism and willingness to discuss mental health, suicide and help-seeking. Our Healthy Clarence draws ideas from mental health care, community development and public health. This initiative could serve as a model for other communities to address suicide, self-harm and improve wellbeing on a whole-of-community scale. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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10 pages, 319 KiB

Open AccessArticle

Demographic and Clinical Characteristics of Military Service Members Hospitalized Following a Suicide Attempt versus Suicide Ideation

by Brianne J. George, Sissi Ribeiro, Su Yeon Lee-Tauler, Allison E. Bond, Kanchana U. Perera, Geoffrey Grammer, Jennifer Weaver and Marjan Ghahramanlou-Holloway

Int. J. Environ. Res. Public Health 2019, 16(18), 3274; https://doi.org/10.3390/ijerph16183274 - 06 Sep 2019

Cited by 3 | Viewed by 2505

Abstract

Psychiatric hospitalization for a suicide attempt (SA), rather than suicide ideation (SI) alone, is a stronger risk indicator for eventual suicide death. Yet, little is known about demographic and clinical characteristics differentiating those admitted for SA versus SI. Understanding these differences has implications [...] Read more.

Psychiatric hospitalization for a suicide attempt (SA), rather than suicide ideation (SI) alone, is a stronger risk indicator for eventual suicide death. Yet, little is known about demographic and clinical characteristics differentiating those admitted for SA versus SI. Understanding these differences has implications for assessment and treatment. A retrospective review of electronic medical records (EMRs) was performed on service members (n = 955) admitted for SA or SI at the Walter Reed Army Medical Center between 2001–2006. Service members hospitalized for SA were younger compared to those hospitalized for SI. The proportion of women admitted for SA was significantly higher than those admitted for SI whereas their male counterparts showed the opposite pattern. Patients admitted for SA, versus SI, had significantly higher prevalence of adjustment disorder with mixed disturbance of emotion and conduct (MDEC), personality disorder not otherwise specified (PDNOS), and borderline personality disorder (BPD). Patients admitted for SI had significantly higher prevalence of adjustment disorder with depressed mood and deferred Axis II diagnosis, compared to those admitted for SA. There were no significant between-group differences in the average or median number of documented prior suicide attempts. Findings highlight the need for more standardized assessment, diagnostic decision-making, and documentation practices for all patients. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

13 pages, 306 KiB

Open AccessArticle

Re-Thinking Ethics and Politics in Suicide Prevention: Bringing Narrative Ideas into Dialogue with Critical Suicide Studies

by Jennifer White and Jonathan Morris

Int. J. Environ. Res. Public Health 2019, 16(18), 3236; https://doi.org/10.3390/ijerph16183236 - 04 Sep 2019

Cited by 12 | Viewed by 5427

Abstract

The purpose of this paper is to explore the conviviality between practices of narrative therapy and the emerging field of critical suicide studies. Bringing together ideas from narrative therapy and critical suicide studies allows us to analyze current suicide prevention practices from a [...] Read more.

The purpose of this paper is to explore the conviviality between practices of narrative therapy and the emerging field of critical suicide studies. Bringing together ideas from narrative therapy and critical suicide studies allows us to analyze current suicide prevention practices from a new vantage point and offers us the chance to consider how narrative therapy might be applied in new and different contexts, thus extending narrative therapy’s potential and possibilities. We expose some of the thin, singular, biomedical descriptions of the problem of suicide that are currently in circulation and attend to the potential effects on distressed persons, communities, and therapists/practitioners who are all operating under the influence of these dominant understandings. We identify some cracks in the dominant storyline to enable alternative descriptions and subjugated knowledges to emerge in order to bring our suicide prevention practices more into alignment with a de-colonizing, social justice orientation. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

9 pages, 297 KiB

Open AccessArticle

Seasonality of Suicides among Victims Who Are under the Influence of Alcohol

by Dorota Lasota, Witold Pawłowski, Paweł Krajewski, Anna Staniszewska, Krzysztof Goniewicz and Mariusz Goniewicz

Int. J. Environ. Res. Public Health 2019, 16(15), 2806; https://doi.org/10.3390/ijerph16152806 - 06 Aug 2019

Cited by 8 | Viewed by 4363

Abstract

Introduction: Suicide is one of the most frequent causes of death. According to the World Health Organization (WHO), each year, over eight hundred thousand people worldwide die as a result of suicide. The most common risk factors for suicide are depressive disorders and [...] Read more.

Introduction: Suicide is one of the most frequent causes of death. According to the World Health Organization (WHO), each year, over eight hundred thousand people worldwide die as a result of suicide. The most common risk factors for suicide are depressive disorders and alcohol dependence. Alcohol can directly influence a decision about suicide, or be a factor facilitating this decision. The aim of the study was to analyse the seasonality of suicides among persons under the influence of alcohol. Material and Methods: Data for analysis were obtained from the Department of Forensic Medicine (DFM) of the Medical University of Warsaw. A retrospective analysis was performed on 317 victims of suicides by hanging, those which were entered into the registry of deaths kept by the DFM in the years 2009–2013. The analysis took into account the age and sex of victims, initial cause of death, date of post-mortem examination, autopsy result and alcohol concentration in the blood or muscles of the victims. Statistical analysis was performed using IBM SPSS Statistics version 20. Results: In the analysis, a spring peak of suicides was found for men, and an autumn peak was revealed for women. In addition, a significant correlation was observed between the age of victims and the concentration of alcohol; the older the victims, the higher the alcohol concentration. However, this correlation was reported only in the spring months. Conclusions: The results of the analysis seem to be consistent with seasonal patterns observed in other studies, and they indicate the occurrence of suicide seasonality. In order to improve the strategies of suicide prevention, it is necessary to identify factors which are related to the seasonal variation of suicidal behaviours, as well as to gain knowledge about the mechanisms behind this phenomenon. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

11 pages, 548 KiB

Open AccessArticle

Construction and Validation of an Analytical Grid about Video Representations of Suicide (“MoVIES”)

by Christophe Gauld, Marielle Wathelet, François Medjkane, Nathalie Pauwels, Thierry Bougerol and Charles-Edouard Notredame

Int. J. Environ. Res. Public Health 2019, 16(15), 2780; https://doi.org/10.3390/ijerph16152780 - 03 Aug 2019

Cited by 4 | Viewed by 3806

Abstract

Background. Exposure to fictional suicide scenes raises concerns about the risk of suicide contagion. However, researchers and clinicians still lack empirical evidence to estimate this risk. Here, we propose a theory-grounded tool that measures properties related to aberrant identification and suicidal contagion of [...] Read more.

Background. Exposure to fictional suicide scenes raises concerns about the risk of suicide contagion. However, researchers and clinicians still lack empirical evidence to estimate this risk. Here, we propose a theory-grounded tool that measures properties related to aberrant identification and suicidal contagion of potentially harmful suicide scenes. Methods. The items of the Movies and Video: Identification and Emotions in reaction to Suicide (MoVIES) operationalize the World Health Organization’s recommendations for media coverage of suicide, and were adapted and completed with identification theory principles and cinematographic evidence. Inter-rater reliability (Cohen’s kappa) and internal consistency (Cronbach’s alpha) were estimated and optimized for two series of 19 and 30 randomly selected movies depicting a suicide scene. The validity of the scale in predicting identification with the suicidal character was tested in nine unknowledgeable participants who watched seven suicide movie scenes each. Results. The MoVIES indicated satisfying psychometric properties with kappas measured at 0.7 or more for every item and a global internal consistency of [α = 0.05]. The MoVIES score significantly predicted participants’ strength of identification independently from their baseline empathy ((β = 0.20), p < 0.05). Conclusions. The MoVIES is available to scholars as a valid, reliable, and useful tool to estimate the amount of at-risk components of fictional suicidal behavior depicted in films, series, or television shows. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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15 pages, 506 KiB

Open AccessArticle

Improving Schools’ Readiness for Involvement in Suicide Prevention: An Evaluation of the Creating Suicide Safety in Schools (CSSS) Workshop

by Patricia Breux and Dana E. Boccio

Int. J. Environ. Res. Public Health 2019, 16(12), 2165; https://doi.org/10.3390/ijerph16122165 - 19 Jun 2019

Cited by 12 | Viewed by 6883

Abstract

Schools have an important role to play in combatting suicide, a significant public health problem that disproportionately affects adolescents and young adults. Schools can work to reduce youth suicidality by adopting policies that align with best practice recommendations pertaining to suicide prevention, intervention, [...] Read more.

Schools have an important role to play in combatting suicide, a significant public health problem that disproportionately affects adolescents and young adults. Schools can work to reduce youth suicidality by adopting policies that align with best practice recommendations pertaining to suicide prevention, intervention, and postvention. This study examined the impact of a one-day training, the Creating Suicide Safety in Schools (CSSS) workshop, on the readiness of school personnel to improve their schools’ suicide-related policies and procedures. Participants (N = 562) consisted predominantly of school-based mental health professionals working in communities of low or mixed socioeconomic status in New York State. Survey data were collected according to a one-group pre-test—post-test design with a 3-month follow-up. Workshop participants demonstrated improvements from pre-test to post-test in their attitudes about the importance of school-based suicide prevention, knowledge of best practices, perceptions of administrative support, and feelings of empowerment to work collaboratively to enhance their schools’ suicide safety. At follow-up, participants reported barriers to implementing changes, most commonly in the form of insufficient time and stigma surrounding the topic of suicide. The results of this study provide preliminary evidence for the effectiveness of the CSSS workshop as a promising method for improving schools’ suicide safety, yet additional research using randomized controlled trials needs to be conducted. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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15 pages, 317 KiB

Open AccessArticle

The Perceived Impact of Suicide Bereavement on Specific Interpersonal Relationships: A Qualitative Study of Survey Data

by Valeriya Azorina, Nicola Morant, Hedvig Nesse, Fiona Stevenson, David Osborn, Michael King and Alexandra Pitman

Int. J. Environ. Res. Public Health 2019, 16(10), 1801; https://doi.org/10.3390/ijerph16101801 - 21 May 2019

Cited by 26 | Viewed by 5069

Abstract

People bereaved by suicide have an increased risk of suicide and suicide attempt, yet report receiving less support than people bereaved by other sudden deaths. Reductions in support may contribute to suicide risk, yet their nature is unclear. We explored the impact of [...] Read more.

People bereaved by suicide have an increased risk of suicide and suicide attempt, yet report receiving less support than people bereaved by other sudden deaths. Reductions in support may contribute to suicide risk, yet their nature is unclear. We explored the impact of suicide bereavement on the interpersonal relationships of young adults in the UK using an online survey to collect qualitative data. We conducted thematic analysis of free-text responses from 499 adults to questions capturing the impact of bereavement on relationships with partners, close friends, close family, extended family, and other contacts. We identified four main themes describing the changes in relationships following the suicide: (1) Social discomfort over the death (stigma and taboo; painfulness for self or others to discuss; socially prescribed grief reactions); (2) social withdrawal (loss of social confidence; withdrawal as a coping mechanism); (3) shared bereavement experience creating closeness and avoidance; (4) attachments influenced by fear of further losses (overprotectiveness towards others; avoiding attachments as protective). These findings contribute to understanding deficits in support and pathways to suicidality after suicide bereavement. Such disrupted attachments add to the burden of grief and could be addressed by public education on how to support those bereaved by suicide. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

9 pages, 292 KiB

Open AccessArticle

Problematic Internet Use in University Students Attending Three Superior Graduate Schools in Italy: Is Autism Spectrum Related to Suicide Risk?

by Liliana Dell’Osso, Carlo Antonio Bertelloni, Marco Di Paolo, Maria Teresa Avella, Barbara Carpita, Federica Gori, Maurizio Pompili and Claudia Carmassi

Int. J. Environ. Res. Public Health 2019, 16(7), 1098; https://doi.org/10.3390/ijerph16071098 - 27 Mar 2019

Cited by 32 | Viewed by 3932

Abstract

Background: Over the past decades, problematic internet use (PIU) has dramatically increased, especially among young people. PIU has been recently associated with autism spectrum disorder (ASD) and autistic traits. Subjects with PIU report an increased suicidal risk and the same has been [...] Read more.

Background: Over the past decades, problematic internet use (PIU) has dramatically increased, especially among young people. PIU has been recently associated with autism spectrum disorder (ASD) and autistic traits. Subjects with PIU report an increased suicidal risk and the same has been demonstrated among patients with ASD. The aim of this study was to investigate putative PIU rates among students and explore the correlation between autistic traits and suicide risk. Methods: A sample of 178 high achieving university students was assessed by means of the Adult Autism Subthreshold Spectrum (AdAS Spectrum), Autism Quotient questionnaire (AQ). Suicide risk was investigated by some specific items of the Trauma and Loss Spectrum-Self Report (TALS-SR) and putative PIU was identified on the basis of a specific AdAS Spectrum item. Results: 27.5% subjects reporting putative PIU. This subgroup showed higher scores in all domains of AdAS Spectrum and AQ compared with others. Students with putative PIU showed a significant correlation between suicide risk and the non-verbal communication domain of the AdAS Spectrum and the Social skills domain of the AQ. Conclusions: We found that students with PIU show higher levels of autistic traits compared to those without PIU. A significant correlation was found between autistic traits and suicide risk. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

12 pages, 722 KiB

Open AccessArticle

Dealing with Ethical Concerns in Suicide Research: A Survey of Australian Researchers

by Karl Andriessen, Lennart Reifels, Karolina Krysinska, Jo Robinson, Georgia Dempster and Jane Pirkis

Int. J. Environ. Res. Public Health 2019, 16(7), 1094; https://doi.org/10.3390/ijerph16071094 - 27 Mar 2019

Cited by 14 | Viewed by 7145

Abstract

Given the increasing trend in suicide mortality and its burden on individuals, families and communities, ethically sound research is crucial to improve the prevention of suicidal behaviour. However, few studies have looked at the experiences of researchers in obtaining ethics approval for their [...] Read more.

Given the increasing trend in suicide mortality and its burden on individuals, families and communities, ethically sound research is crucial to improve the prevention of suicidal behaviour. However, few studies have looked at the experiences of researchers in obtaining ethics approval for their studies. This study addressed this gap by investigating researchers’ experiences in obtaining ethics approval and how they dealt with the concerns raised by ethics committees. Respondents were recruited from September to November 2018 through the Australian Suicide Prevention Research Leaders Network, and 33 respondents (35%) completed the study survey, comprising forced-choice and open-ended questions. Respondents most commonly reported concerns from ethics committees regarding potential harm to participants and researchers’ responsibilities to participants within the context of intervention and evaluation studies. Most researchers modified their ethics application and/or consulted with their ethics committee to reply to the concerns raised. Most respondents perceived the impact of the modification as positive or neutral. The study concludes that researchers may anticipate potential concerns of ethics committees. Improved understanding of how ethics committees work and dialogue between researchers and ethics committees should sustain the quality in suicide-related research. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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14 pages, 960 KiB

Open AccessArticle

From Substance Use Disorders in Life to Autopsy Findings: A Combined Case-Record and Medico-Legal Study

by Louise Brådvik, Peter Löwenhielm, Arne Frank and Mats Berglund

Int. J. Environ. Res. Public Health 2019, 16(5), 801; https://doi.org/10.3390/ijerph16050801 - 05 Mar 2019

Cited by 2 | Viewed by 2728

Abstract

Objectives: Several studies have shown mortality and suicide risk in substance use disorders, and autopsy findings with respect to the used substances. However, there seems to be a gap in the knowledge about substances misused in life and at death at the within-person [...] Read more.

Objectives: Several studies have shown mortality and suicide risk in substance use disorders, and autopsy findings with respect to the used substances. However, there seems to be a gap in the knowledge about substances misused in life and at death at the within-person level. Methods: All consecutive, autopsied patients during 1993 to 1997, who had been in contact with the Addiction Centre in Malmö from 1968, were investigated (365 subjects). Drug misuse in the long-term course noted in case records was related to autopsy findings. Self-inflicted death (suicide/undetermined suicide/accidental overdose) was compared with natural death. Results: Benzodiazepine misuse was associated with a high risk of autopsy findings of the substance in suicide and death of undetermined intent. It was also associated among non-misusers, but less so. An alcohol level above 1‰ was found more often in self-inflicted death. Prescription opioids at autopsy were mainly found in self-inflicted death among non-misusers. Heroin misuse was related to overdose. Central nervous system stimulants (CNS-S) and cannabis were rarely found in self-inflicted death among previous misusers. The overlap between depression in life and antidepressants at death was low. Conclusions: Benzodiazepines and alcohol seem to disinhibit suicidal tendencies. Suicide risk among users of cannabis and CNS-S may be related to other risk factors than acute use. Implications for suicide prevention are discussed. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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Review

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14 pages, 820 KiB

Open AccessReview

One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

by David A. Jobes and Samantha A. Chalker

Int. J. Environ. Res. Public Health 2019, 16(19), 3606; https://doi.org/10.3390/ijerph16193606 - 26 Sep 2019

Cited by 28 | Viewed by 10224

Abstract

While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and [...] Read more.

While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, a “one-size-fits-all” approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical care of suicidal risk that is cost-effective, least-restrictive, and evidence-based. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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23 pages, 1205 KiB

Open AccessReview

What Is the Experience of Practitioners in Health, Education or Social Care Roles Following a Death by Suicide? A Qualitative Research Synthesis

by Hilary Causer, Kate Muse, Jo Smith and Eleanor Bradley

Int. J. Environ. Res. Public Health 2019, 16(18), 3293; https://doi.org/10.3390/ijerph16183293 - 07 Sep 2019

Cited by 11 | Viewed by 7062

Abstract

Recent research has highlighted that the number of people impacted by a death by suicide is far greater than previously estimated and includes wider networks beyond close family members. It is important to understand the ways in which suicide impacts different groups within [...] Read more.

Recent research has highlighted that the number of people impacted by a death by suicide is far greater than previously estimated and includes wider networks beyond close family members. It is important to understand the ways in which suicide impacts different groups within these wider networks so that safe and appropriate postvention support can be developed and delivered. A systematic review in the form of a qualitative research synthesis was undertaken with the aim of addressing the question ‘what are the features of the experiences of workers in health, education or social care roles following the death by suicide of a client, patient, student or service user?’ The analysis developed three categories of themes, ‘Horror, shock and trauma’, ‘Scrutiny, judgement and blame’, and ‘Support, learning and living with’. The mechanisms of absolution and incrimination were perceived to impact upon practitioners’ experiences within social and cultural contexts. Practitioners need to feel prepared for the potential impacts of a suicide and should be offered targeted postvention support to help them in processing their responses and in developing narratives that enable continued safe practice. Postvention responses need to be contextualised socially, culturally and organisationally so that they are sensitive to individual need. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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26 pages, 533 KiB

Open AccessReview

A Systematic Review of the Antecedents and Prevalence of Suicide, Self-Harm and Suicide Ideation in Australian Aboriginal and Torres Strait Islander Youth

by Joanne M. Dickson, Kate Cruise, Clare A. McCall and Peter J. Taylor

Int. J. Environ. Res. Public Health 2019, 16(17), 3154; https://doi.org/10.3390/ijerph16173154 - 29 Aug 2019

Cited by 35 | Viewed by 12565

Abstract

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm [...] Read more.

Suicide and self-harm represent serious global health problems and appear to be especially elevated amongst indigenous minority groups, and particularly amongst young people (aged 24 years or younger). This systematic review investigates for the first time the antecedents and prevalence of suicide, self-harm and suicide ideation among Australian Aboriginal and Torres Strait Islander youth. Web of Science, PubMed, PsychINFO, CINAHL databases and grey literature were searched from earliest records to April 2019 for eligible articles. Twenty-two empirical articles met the inclusion criteria. The data confirmed that indigenous youth in Australia have elevated rates of suicide, self-harm and suicidal ideation relative to the nonindigenous population. Risk factors included being incarcerated, substance use and greater social and emotional distress. Notably, though, information on predictors of suicide and self-harm remains scarce. The findings support and justify the increasing implementation of public health programs specifically aimed at tackling this crisis. Based on the review findings, we argued that Aboriginal communities are best positioned to identify and understand the antecedents of youth self-harm, suicide ideation and suicide, and to take the lead in the development of more effective mental health preventive strategies and public policies within their communities. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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Other

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13 pages, 709 KiB

Open AccessProtocol

Rethinking Suicide in Rural Australia: A study Protocol for Examining and Applying Knowledge of the Social Determinants to Improve Prevention in Non-Indigenous Populations

by Scott J. Fitzpatrick, Bronwyn K. Brew, Donna M. Y. Read, Kerry J. Inder, Alan Hayes and David Perkins

Int. J. Environ. Res. Public Health 2019, 16(16), 2944; https://doi.org/10.3390/ijerph16162944 - 16 Aug 2019

Cited by 3 | Viewed by 6781

Abstract

Disproportionate rates of suicide in rural Australia in comparison to metropolitan areas pose a significant public health challenge. The dynamic interrelationship between mental and physical health, social determinants, and suicide in rural Australia is widely acknowledged. Advancement of this knowledge, however, remains hampered [...] Read more.

Disproportionate rates of suicide in rural Australia in comparison to metropolitan areas pose a significant public health challenge. The dynamic interrelationship between mental and physical health, social determinants, and suicide in rural Australia is widely acknowledged. Advancement of this knowledge, however, remains hampered by a lack of adequate theory and methods to understand how these factors interact, and the translation of this knowledge into constructive strategies and solutions. This paper presents a protocol for generating a comprehensive dataset of suicide deaths and factors related to suicide in rural Australia, and for building a program of research to improve suicide prevention policy and practice to better address the social determinants of suicide in non-indigenous populations. The two-phased study will use a mixed-methods design informed by intersectionality theory. Phase One will extract, code, and analyse quantitative and qualitative data on suicide in regional and remote Australia from the National Coronial Information System (NCIS). Phase Two will analyse suicide prevention at three interrelated domains: policy, practice, and research, to examine alignment with evidence generated in Phase One. Findings from Phase One and Two will then be integrated to identify key points in suicide prevention policy and practice where action can be initiated. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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6 pages, 289 KiB

Open AccessProtocol

Evaluation of A Suicide Prevention Program in Switzerland: Protocol of A Cluster Non-Randomized Controlled Trial

by Stéphanie Baggio, Abbas Kanani, Neslie Nsingi, Marlène Sapin and Raphaël Thélin

Int. J. Environ. Res. Public Health 2019, 16(11), 2049; https://doi.org/10.3390/ijerph16112049 - 10 Jun 2019

Cited by 3 | Viewed by 4619

Abstract

Suicide is a major public health concern, which disproportionally affects young people. Therefore, effective prevention strategies are needed, but there is a dearth of controlled trials on this topic. Our study will evaluate the effectiveness of a suicide prevention program in Switzerland, where [...] Read more.

Suicide is a major public health concern, which disproportionally affects young people. Therefore, effective prevention strategies are needed, but there is a dearth of controlled trials on this topic. Our study will evaluate the effectiveness of a suicide prevention program in Switzerland, where data are scarce. It will test whether the prevention program (1) increases knowledge of suicide and awareness of suicidal risks, (2) provides resources to seek/offer help, (3) increases communication skills related to suicide, (4) increases coping skills, (5) is acceptable, and (6) reduces suicidal ideation and psychological distress. The project will be a single-center cluster non-randomized controlled trial designed to compare an intervention group benefitting from the suicide prevention program with a control group. The potential benefits include a better understanding and evaluation of suicide prevention programs, which may lead to improved primary and secondary prevention practices. Full article

(This article belongs to the Special Issue Suicide: Prevention, Intervention and Postvention)

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