Nurses's Attitudes in Preventing Suicide: a Survey.

INTRODUCTION: Nowadays, suicide represents a serious public health problem worldwide. Nurses can play a critical role in suicide prevention. Knowing risk factors and recognizing warning signs for suicide should be part of the professional background of any nurse training programs. METHODS: Our study presents the preliminary descriptive findings from an online survey in nursing staff operating in various areas (medical, surgical, critical and emergency) in the Apulia region. The survey aimed to assess the current knowledge, attitudes, behaviors and training needs of nurses regarding suicide prevention. We administered a questionnaire created with Google forms to a sample of subjects obtained through sampling a reasoned choice. RESULTS AND CONCLUSIONS: Our study highlighted the lack of perceived competence toward the suicidal patient and the need to implement specific training programs for nurses on the management of patients at risk of suicide. An adequate level of knowledge and competence regarding suicide prevention among healthcare professionals could significantly contribute to improving the quality of care provided to patients at risk for suicide, reducing the risk of suicidal events and improving the overall quality of the care pathway.

Risk Assessment Suicidality Scale (RASS)-Based On-Line Calculator Targeting Early Prevention of Suicides in General Population: from COMET-G Study Results Towards Integration of the Screening Tool into Routine Clinical Practice.

BACKGROUND: Suicide is a major global health concern, particularly among young people. This study evaluates an online suicide risk calculator based on the Risk Assessment of Suicidality Scale (RASS), which is designed to enhance accessibility and early detection of suicide risk. METHODS: The study involved 444 participants who completed the RASS via an online calculator. Results were compared with data from the COMET-G study's Russian sample (n=7572). Descriptive statistics, correlation analysis, and two-way ANOVA were used to analyze the data. RESULTS: The mean age of participants was 22.71 years (SD=7.94). The mean total RASS standardized score was 837.7 (SD=297.8). There was a significant negative correlation between age and RASS scores (r=-0.463, p<0.0001). The online calculator sample showed significantly higher RASS scores compared to the COMET-G sample, with 71% of online users scoring above the 90th percentile of the COMET-G sample. CONCLUSION: Our study demonstrated the advantage of the on-line suicidality risk calculator based on the RASS scale as a sensitive tool in detecting suicidal behaviours and measuring the severity of suicidality risks, offering a capability for broad reach and immediate assessment during clinical conversation between doctor and patient. Moreover, the RASS on-line psychometric instrument, when being freely distributed among the general population over internet sources, enabled to attract vulnerable groups of respondents with significantly higher suicidality risks. Future research should focus on integrating such tools into comprehensive suicide prevention programs and developing appropriate follow-up monitoring strategies for high risk-cases.

Suicide Pact: Till Death Do Us Part .

BACKGROUND: Suicide pacts are always tragic though they remain under-identified and under-reported. History and fiction are full of them, though they would only represent less than one percent of all suicides in Occident. A suicide pact is an agreement made between two or more people to commit suicide together and requires a reciprocal consent but also intent, volition and capability. Victims, motivations and operating methods are multiple, and continue to diversify even more with Internet and social media. How can we identify people at risk? SUBJECTS AND METHODS: Between November 2023 and May 2024, a literature search based on electronic bibliographic databases as well as other sources of information (grey literature) was conducted in order to investigate the most recent data on suicide pacts and especially how they evolved with Internet and social media. RESULTS: Different categories of suicide pacts can be made, but the typical template for a prospective suicide pact describes as two withdrawn individuals, in a tight and close relationship, who feel ensnared in a desperate and unmitigable situation. CONCLUSIONS: Prevention can done at various levels, but screening individuals who fit the profile for risk would certainly be a start. To identify a suicide pact, forensics, criminology and sociology need to be considered.

Efficacy of an online gatekeeper program for relatives of men at risk of suicide - a randomized controlled trial.

BACKGROUND: Men at risk for suicide are a challenging population group to reach with suicide prevention strategies. Gatekeepers hold a pivotal role in the prevention of male suicide, yet effective intervention requires them to have a level of knowledge and strategies to provide support. AIM: This study aimed to examine the efficacy of an online gatekeeper program for gatekeepers in male suicide prevention, assessing knowledge, perceived preparedness, self-efficacy, and psychopathological symptoms of gatekeepers. METHODS: Eighty-four participants were randomized to either the intervention (n = 43) or the waitlist control group (n = 41). The intervention comprised four modules providing knowledge and strategies for addressing men in suicidal crises. Outcomes included depression (PHQ-9), distress (PSS-10), burden (BAS), involvement (IEQ), as well as gatekeeper outcomes and knowledge. RESULTS: Completer analyses revealed significant improvement of depressive symptoms (d = 0.39) and an increase in gatekeeper outcomes (d = 0.58 to d = 0.84) and knowledge (d = 0.62) from baseline to post-assessment. The effects were maintained for 3 months. No significant effects could be found for burden, distress, and involvement. CONCLUSIONS: The findings indicate that a brief gatekeeper program can serve as a valuable resource. Future research should focus on examining the mental health of gatekeepers themselves and its long-term effects on intervention behavior. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00030758, registered on 05.12.2022.

Editorial for Special Issue on Understanding and Prevention of Suicidal Behavior: Humanizing Care and Integrating Social Determinants.

BACKGROUND: Suicide is a preventable public health and social problem. Suicidal behavior is a complex and multifactorial phenomenon whose characterization, assessment, prevention, intervention, and postvention require a comprehensive approach focused on the meaning in a person's life and their suffering in their biographical, social and cultural context. It is an extraordinarily variable phenomenon over time and highly dependent on contextual elements. METHOD: This editorial includes the social determinants of this phenomenon, key aspects linked to the dehumanization of healthcare settings, the problems of iatrogenic harm in universal prevention programs for schoolchildren and adolescents, and good clinical practices collected in the scientific literature. RESULTS: The editorial highlights the importance of research for the prevention of suicidal behavior from any intervention level, whether educational, community, social, or health, as all are involved in prevention. CONCLUSIONS: The goal is to help improve the biographical circumstances of people with suicidal behaviors and the meaningfulness of their lives. This must be done through a collective scaffolding in which the most vulnerable can ask for help when they need it, as well as guide themselves towards life circumstances worth living.

A Nunavut community-directed Inuit youth mental wellness initiative: making I-SPARX fly.

Inuit youth in Nunavut (NU) are resilient but face a protracted suicide crisis. The SPARX serious game and e-intervention, developed originally in New Zealand, teaches youth cognitive behavioural therapy (CBT) skills to ameliorate stress and depression. Inuit youth in NU reviewed and culturally adapted SPARX and an existing wellness outcome measure for Inuit. One hundred and twenty-one youth, aged 13 to 24, across NU then tested, played, and evaluated I(nuit)-SPARX, showing improvement in several areas of wellbeing post-play. Youth completed a CBT skills survey, engaged in sharing circles to assess CBT skill retention, and shared their thoughts about the usefulness and cultural fit of I-SPARX with Inuit Qaujimajatuqangit (IQ). Communication Skills, Listening Skills, and Problem Solving emerged as the most helpful learned CBT skills, and NU youth provided real-world examples of using I-SPARX skills to support their mental wellness. Several principles of IQ were exemplified and upheld in the content of the adapted SPARX tool and the process of the project as a whole. Empirically grounded, asynchronous e-tools, developed in collaboration with Inuit communities to ensure cultural specificity, may support psychological wellness in communities where mental health resources are scarce.

Evaluating suicide prevention gatekeeper training designed to identify and support people from asylum-seeking and refugee backgrounds.

BACKGROUND: Suicide-related behaviours and individual risk factors for suicide differ between ethnicities and demonstrate additional variation based on voluntary and forced migration. People forcibly displaced by violence and conflict, such as those seeking asylum and refugees, are likely to face stressors that can increase suicide risk. Research into evidenced-based suicide prevention strategies among people from asylum-seeking and refugee backgrounds is scarce. However, early, contextually-appropriate, identification and intervention may be a promising way to facilitate support for people in these groups. This research proposes that a contextually-responsive gatekeeper training is an appropriate strategy to increase the identification and support for people from asylum-seeking and refugee backgrounds. METHODS: The present article relates to the statistical findings of a larger mixed-method study used to validate and refine a contextually-responsive gatekeeper training program. The qualitative results of this research will be published separately. The outcome measures - knowledge about suicide in multicultural contexts, attitudes towards suicide and prevention, and self-efficacy to intervene were measured quantitatively, adopting a similar pre- and post-training procedure used in previous training evaluations. Using Generalised Estimating Equations, statistical comparisons were made between three identical self-report surveys completed by participants across three consecutive time points - pre-training, immediately post-training, and three months following training completion - known in this investigation as time-point zero (T0), time-point one (T1), and time-point two (T2). Lastly, during the T2 follow-up, additional open-ended questions were included to understand which areas of training they feel prepared them effectively and how the program could have better prepared them to intervene. RESULTS: A total of 28 participants took part in the study. Quantitative analysis indicated the program's capacity to exert a significant favourable and lasting influence on knowledge about suicide and self-efficacy to intervene. In addition, follow-up measurements suggest that the content delivered to participants transferred effectively into real-world suicide prevention behaviours. CONCLUSIONS: Findings suggest that tailored suicide prevention training can have a significant influence on knowledge about suicide in multicultural contexts, self-efficacy to intervene in a crisis, and that course content translates effectively into real-world suicide prevention behaviour. Modifying training practices, based on feedback from contextually-experienced attendees, appears to be a pivotal factor in promoting the support of people from asylum-seeking and refugee backgrounds.

Social Media and Suicide Risk in Youth.

Importance: Youth, parents, educators, and policymakers are concerned about the potential relationship between social media use and negative mental health outcomes, including risk for suicidal thoughts and behaviors. Observations: Current research shows complex and conflicting relationships between social media use and suicide risk. A key limiting factor in clarifying these relationships is a dearth of available information on contextual factors around social media use, with most research focusing only on hours or amount of engagement. Whereas there are clear associations between some types of social media use and suicide risk, there are also many opportunities to mitigate suicide risk through social media. Several methodologic and measurement issues make research challenging. Researchers have only begun to explore how specific risk factors interact with individual vulnerabilities, how social media can be used to enhance youth well-being, and whether and under what circumstances mitigation strategies can be helpful. Conclusions and Relevance: This overview identifies research gaps and methodological challenges that need to be addressed to guide intervention strategies and future policy relevant to youth and suicide risk.

The role of social identity in a suicide prevention programme for construction workers in Australia.

Each year, more than 700 000 people die by suicide globally, the majority of whom are men. The United Nations and World Health Organization have set targets to reduce suicide rates by one-third by 2030. While large-scale suicide prevention programmes are required to meet these targets, diffusion of these types of initiatives is difficult-particularly with male populations. This qualitative study investigated the MATES in Construction suicide prevention programme in Australia. Guided by Social Identity Theory and the Social Identity Model for Collective Action, the study aimed to understand why construction workers chose to volunteer and advocate for industry-based suicide prevention programmes, and how their worker identity, solidarity and relationships impacted their volunteering and advocacy. Semi-structured interviews were conducted with 28 participants who had chosen to engage with MATES as volunteers. Data were interpreted using a reflexive approach to thematic analysis, and four themes were constructed from the data relating to feelings of belonging, connection and solidarity between workers and their industry; how specific context and roles impacted identity while existing within an overall sense of identity and solidarity; how industry mateship supported engagement in suicide prevention; and how the role of lived experience, mateship and responsibility provided hope for change. Providing intervention skills to workers, particularly workers with a lived experience of mental ill-health, empowered them to believe that they could make a difference by acting collectively. The MATES engagement model described in this study may have applications for other health promotion prevention programmes targeting male cultures.

Contactless monitoring to prevent self-harm and suicide in custodial settings: Protocol for a global scoping review.

INTRODUCTION: Self-harm and suicide are major contributors to the global burden of disease and people in custodial settings are at a markedly increased risk of these adverse outcomes. Contactless monitoring technology is emerging as a possible solution to prevent self-harm and suicide by detecting and predicting vulnerabilities among people at increased risk in custodial settings in realtime, however no reviews to date have synthesized the evidence base, in the custodial context, regarding (a) the extent to which this technology has been implemented; and (b) the acceptability and feasibility of its application among custodial staff, specifically in relation to maintaining the wellbeing and safety of both incarcerated people and custodial professionals. METHODS AND ANALYSIS: Our scoping review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. We searched key electronic health and social science databases (MEDLINE, PubMed, Scopus, Web of Science, ProQuest and Google Scholar) on 5 February 2024 for peer-reviewed studies, which report on the use of contactless monitoring in custodial settings. Any type of study design was eligible, and the publication format was not limited. We included quantitative peer-reviewed journal articles, all types of reviews (narrative, systematic and meta-analysis) and did not apply study eligibility restrictions on country of origin. We will also search grey literature. Inclusion of publications will be restricted to the English language. ETHICS AND DISSEMINATION: This review does not require institutional ethics review or approval as it is a review of studies that have already been granted relevant ethics approval. Our dissemination strategy includes a peer-reviewed publication and presentations at relevant national and international academic conferences. A plain language summary will be distributed through consumers and professional networks.

Validation of the Spanish Version of the Nurses' Global Assessment of Suicide Risk Scale (NGAR) in Nonclinical Settings.

AIM: To validate the Nurses' Global Assessment of Suicide Risk (NGASR) in Spanish for an early detection identification of the risk of suicide. DESIGN: A descriptive cross-sectional survey design was used for this work through face-to-face clinical interviews with each participant. METHOD: Following EQUATOR TRIPOD checklist, the index was translated and administered to a sample of 30 mental health experts and 151 university students. To examine the psychometric properties of the NGASR, the questionnaires also included other standardised scales such as BDI, SBQ and SEEQ. The research was conducted between 2022 and 2023. RESULTS: The content validity index-scale (CVI-S) was 81% and the NGASR presented high reliability with a Kuder-Richardson coefficient of 0.83. Exploratory factor analysis (EFA) returned a six-factor structure for the NGASR items. The results showed that 21.7% of the students assessed had an intermediate to very high suicide risk. This study also revealed that people with mental health problems and depression had a higher risk of suicide. PUBLIC CONTRIBUTION: Beyond the sociolinguistic Spanish validation of the scale, it should be noted that it is carried out on a young population in a nonclinical environment, something that many authors have been requesting in their previous validations. The NGASR is a useful prevention tool in university educational settings.

[Autonomy promoting policy for complex chronic suicidality]. / Autonomiebevorderend beleid bij complexe chronische suïcidaliteit.

Suicidality is prevalent in mental healthcare settings. A small subset of patients exhibiting severe, chronic suicidal tendencies place a significant demand on healthcare services. Existing guidelines offer insufficient guidance, and crisis interventions often yield counterproductive results. This culminates in a pattern of securing and controlling, lacking adequate prospects for recovery and potentially causing harm to the patient. In order to develop a more effective treatment approach, an autonomy promoting policy (APP) has been formulated by the authors. In this article the background and dilemma’s surrounding the APP will be described based on a fictional patient case, and describes how the guide helps in these situations.

Addressing student mental health and suicide concerns: are we there yet?

The mental health and suicide rates of further education (FE) and higher education (HE) students have been generating international concern in many countries, including the United States of America (USA), United Kingdom (UK), Canada, Australia, and Ireland. Several charters and national frameworks have emerged to support and inform whole institution provision. There is evidence of sector engagement and investment to support implementation in HE and to a lesser extent, FE, particularly from the USA and UK, although effectiveness evidence is currently lacking. Barriers affecting help seeking and early identification of difficulties, delays in accessing appropriate support, and lack of continuity of care from campus supports into specialist Mental Health services, remain key challenges. This editorial discusses the current position and the next stage of development in student mental health support and suicide prevention. Overall, the transformation of FE and HE provision to address student mental health and suicide concerns still has a considerable way to go.

Design of a multicenter randomized controlled trial of a post-discharge suicide prevention intervention for high-risk psychiatric inpatients: The Veterans Coordinated Community Care Study.

BACKGROUND: The period after psychiatric hospital discharge is one of elevated risk for suicide-related behaviors (SRBs). Post-discharge clinical outreach, although potentially effective in preventing SRBs, would be more cost-effective if targeted at high-risk patients. To this end, a machine learning model was developed to predict post-discharge suicides among Veterans Health Administration (VHA) psychiatric inpatients and target a high-risk preventive intervention. METHODS: The Veterans Coordinated Community Care (3C) Study is a multicenter randomized controlled trial using this model to identify high-risk VHA psychiatric inpatients (n = 850) randomized with equal allocation to either the Coping Long Term with Active Suicide Program (CLASP) post-discharge clinical outreach intervention or treatment-as-usual (TAU). The primary outcome is SRBs over a 6-month follow-up. We will estimate average treatment effects adjusted for loss to follow-up and investigate the possibility of heterogeneity of treatment effects. RESULTS: Recruitment is underway and will end September 2024. Six-month follow-up will end and analysis will begin in Summer 2025. CONCLUSION: Results will provide information about the effectiveness of CLASP versus TAU in reducing post-discharge SRBs and provide guidance to VHA clinicians and policymakers about the implications of targeted use of CLASP among high-risk psychiatric inpatients in the months after hospital discharge. CLINICAL TRIALS REGISTRATION: ClinicalTrials.Gov identifier: NCT05272176 (https://www. CLINICALTRIALS: gov/ct2/show/NCT05272176).

Evidence-Based Youth Suicide Prevention and Intervention in Pediatric Primary Care Settings.

Suicide is a leading cause of death in youth. Evidence highlights the importance of identifying youth at risk for suicide in pediatric primary care, and suggests this is a crucial setting for improving youth mental health. The American Academy of Pediatrics recommends primary care providers not only screen and assess for suicide risk, but also become educated on how to better manage certain mental health conditions. This article discusses the epidemiology of youth suicide in the United States and describes evidence-based strategies and innovative practices for suicide prevention in pediatric primary care including suicide risk screening, assessment, intervention, and follow-up care.

[Clinical Pathway for Suicide Risk Screening in Adult Primary Care Settings:Special Recommendations]. / Klinikai útvonal az öngyilkossági kockázat szurésére a felnott alapellátásban: Speciális ajánlások.

Suicide is a serious public health concern. On average, 80% of suicide decedents had contact with primary care within one year of their suicide. This and other research underscore the importance of screening for suicide risk within primary care settings, and implementation of suicide risk screening is already underway in many practices. However, while primary care practices may be familiar with screening for other mental health concerns (e.g., depression), many feel uncomfortable or unprepared for suicide risk screening. To meet the increasing demand for evidence-based suicide-risk screening guidance, we provide a clinical pathway for adult primary care practices (to include family medicine, internal medicine, women's health). The pathway was developed by experts with research, clinical expertise and experience in suicide risk screening and primary care. We also provide detailed guidance to aid primary care practices in their decisions about how to implement the clinical pathway.

Association Between School-Related Google Trends Search Volume and Suicides Among Children and Adolescents in Japan During 2016-2020: Retrospective Observational Study With a Time-Series Analysis.

BACKGROUND: Suicide is the leading cause of death among children and adolescents in Japan. Internet search volume may be useful in detecting suicide risk. However, few studies have shown an association between suicides attempted by children and adolescents and their internet search volume. OBJECTIVE: This study aimed to examine the relationship between the number of suicides and the volume of school-related internet searches to identify the search terms that could serve as the leading indicators of suicide prevention among children and adolescents. METHODS: We used data on weekly suicides attempted by elementary, middle, and high school students in Japan from 2016 to 2020, provided by the National Police Agency. Internet search volume was weekly data for 20 school-related terms obtained from Google Trends. Granger causality and cross-correlation analysis were performed to estimate the temporal back-and-forth and lag between suicide deaths and search volume for the related terms. RESULTS: The search queries "I do not want to go to school" and "study" showed Granger causality with suicide incidences. The cross-correlation analysis showed significant positive correlations in the range of -2 to 2 for "I do not want to go to school" (highest value at time lag 0, r=0.28), and -1 to 2 for "study" (highest value at time lag -1, r=0.18), indicating that the search volume increased as the number of suicides increased. Furthermore, during the COVID-19 pandemic period (January-December 2020), the search trend for "I do not want to go to school," unlike "study," was highly associated with suicide frequency. CONCLUSIONS: Monitoring the volume of internet searches for "I do not want to go to school" could be useful for the early detection of suicide risk among children and adolescents and for optimizing web-based helpline displays.