A systematic review of psychosocial protective factors against suicide and suicidality among older adults.

BACKGROUND: Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults. METHOD: First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis. RESULTS: A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures. CONCLUSION: Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.

Medical assistance in dying in Canada: A scoping review on the concept of suffering.

OBJECTIVES: Medical Assistance in Dying (MAiD) has been legal in Canada since June 2016. A person can receive MAiD if their suffering cannot be relieved under conditions that they consider acceptable. Informed consent requires that the person requesting MAiD has received all the information needed to make their decision; that is, medical diagnosis and prognosis, available treatments including palliative care. The evaluation of unbearable suffering is known to be challenging as suffering is often psychological, existential, and social in nature. While interventions to relieve suffering exist, it is unclear how suffering is assessed and addressed in the literature on MAiD practice. No scoping review exists on the topic in Canada. The aim of this study was to understand how the concept of suffering was approached within the Canadian MAiD grey (GL) and scientific (peer-reviewed) literature (SL), specifically: 1- How suffering is defined and assessed in the context of MAiD in Canada and 2- Which interventions in response to suffering are recommended within the process of obtaining informed consent for MAiD and throughout the process of MAiD itself. METHODS: A scoping review was conducted based on PRISMA-SR guidelines. SL articles (N = 1027) were identified from a review of 6 databases and GL documents (N = 537) were obtained from the provinces of Quebec, Ontario and British Columbia. Documents were analyzed using NVivo with coding by two-raters and continuous team discussions. RESULTS: A multidimensional definition of suffering, akin to the concept of total pain, is used. The assessment of suffering is based upon patients' reports. Tools to aid in the assessment are not comprehensively covered. Specific interventions to address suffering were often focused on active listening and the management of physical symptoms. No specific interventions were mentioned and there was no reference to clinical practice guidelines in the grey literature to address other components of suffering. The use of a multidisciplinary approach is suggested without specifying the nature of involvement. CONCLUSIONS: Our review indicates that published guidelines of MAID assessments could include clearer structure around the assessment and management of suffering, with suggestions of tools that may help clarify types of suffering and reference to clinical practice guidelines and interventions to holistically attend to patient suffering with an attention on non-physical symptoms. Guidelines would benefit from clearer explanations of how members of an interdisciplinary teams could be coherently coordinated.

Psychological and Interpersonal Factors Associated with Sexualized Drug Use Among Men Who Have Sex with Men: A Mixed-Methods Systematic Review.

Chemsex-the use of specific drugs during planned sexual activity to sustain or enhance sexual functioning (Bourne et al., 2015)-is widely reported as a major public health issue among gay, bisexual, and other men who have sex with men (GBM) in Western countries. Considering current evidence surrounding Chemsex, we conducted a mixed-methods systematic review regarding psychological and interpersonal factors associated with Chemsex behaviors among GBM. Publications covering Chemsex and psychological or social variables were eligible. Theoretical papers and studies solely presenting physical health outcomes were excluded. 35 English papers published between January 2008 and June 2019 were identified through PubMed, Scopus, and PsycINFO. We performed a parallel-results convergent synthesis (Hong, Pluye, Bujold, & Wassef, 2017) on results extracted from qualitative and quantitative studies comprising the final corpus. Qualitative data suggest that six mechanisms promote Chemsex-related behaviors: dealing with painful emotions or stressful events; normalization and risk minimization of sexualized drug use; giving into interpersonal pressure or fulfilling desire for community belonging; increasing intimacy or connectedness; enhancing sexual performance and functioning; lessening interpersonal and sexual inhibitions. In quantitative reports, six variable categories emerged: sexual control and self-efficacy; sexual functioning; mental health; attitudes toward substance use; life stressors and internalized stressors; and identification with sexual identities or scenes. This review summarizes key psychological and interpersonal correlates of Chemsex among GBM. Further research is needed to replicate current findings and explore new hypotheses across multiple GBM sociodemographic groups and cultural contexts, following best practices in sampling for hard-to-reach populations.

Information and Communication Technology Use in Suicide Prevention: Scoping Review.

BACKGROUND: The use of information and communication technology (ICT) in suicide prevention has progressed rapidly over the past decade. ICT plays a major role in suicide prevention, but research on best and promising practices has been slow. OBJECTIVE: This paper aims to explore the existing literature on ICT use in suicide prevention to answer the following question: what are the best and most promising ICT practices for suicide prevention? METHODS: A scoping search was conducted using the following databases: PubMed, PsycINFO, Sociological Abstracts, and IEEE Xplore. These databases were searched for articles published between January 1, 2013, and December 31, 2018. The five stages of the scoping review process were as follows: identifying research questions; targeting relevant studies; selecting studies; charting data; and collating, summarizing, and reporting the results. The World Health Organization suicide prevention model was used according to the continuum of universal, selective, and indicated prevention. RESULTS: Of the 3848 studies identified, 115 (2.99%) were selected. Of these, 10 regarded the use of ICT in universal suicide prevention, 53 referred to the use of ICT in selective suicide prevention, and 52 dealt with the use of ICT in indicated suicide prevention. CONCLUSIONS: The use of ICT plays a major role in suicide prevention, and many promising programs were identified through this scoping review. However, large-scale evaluation studies are needed to further examine the effectiveness of these programs and strategies. In addition, safety and ethics protocols for ICT-based interventions are recommended.

Marital functioning and psychological distress among older couples over an 18-month period.

Many authors have underlined the existence of a negative association between marital functioning and psychological distress. However, little is known about the direction of this association over time among older couples. This study examined the relation over time between psychological distress and marital functioning among 394 community-dwelling couples. The authors conducted dyadic data analyses to determine whether marital functioning at baseline (T1) predicted psychological distress 18 months later (T2), and inversely. The results for women suggested that marital and psychological functioning may each predict the other. The results for men showed that marital problems lead to more psychological distress. The authors found some significant partner effects: In both genders, the marital functioning of one spouse influenced the marital functioning of the other. Men's marital functioning at baseline significantly predicted women's psychological distress at T2. The authors conducted analyses also to determine how 6 patterns of change in marital functioning between times were associated with changes in psychological distress, and inversely. Changes characterized by an increase in psychological distress over time in at least 1 spouse were associated with a decrease in marital functioning. These findings underlined the importance for clinicians and researchers to pay closer attention to the association between these variables.

Systematic Review of Research and Interventions With Frequent Callers to Suicide Prevention Helplines and Crisis Centers.

Background: Helplines worldwide have frequent callers who may occupy a large proportion of call volume. Therapeutic gain from frequent calling has been questioned. We conducted this review to identify the characteristics of frequent callers and to compile recommendations about how best to help them. Method: Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards, we searched for all empirical research in English and French from inception to May, 2020 in PubMed, PsycInfo, and the CRISE library. Results: We identified 738 manuscripts and retained 27 for analyses. Nine provided no definition of frequent callers; nine mixed frequent callers with repeat callers (>1 calls); nine concerned frequent callers (≥8 calls/month). The limited data suggest frequent callers are similar to other callers and often experience mental health problems, loneliness, and suicide risk. From recommendations in all 27 studies, we identified 10 suggestions to better manage and help frequent callers that merit validation. Limitations: The small number of empirical investigations and the diversity of their goals and methodologies limit generalizations. Although recommendations for helping callers may have face validity, empirical data on their effectiveness are scarce. Conclusion: Rather than focusing on reducing call frequency, we should empirically evaluate the benefits of interventions for frequent callers with different calling patterns, characteristics, and reasons for calling.

Impact of Railway Critical Incidents on Train Drivers and Effectiveness of Critical Incident Management and Support Protocols: A Recovery Trajectory Analysis.

OBJECTIVE: Train drivers are regularly involved in railway critical incidents (CI) and critical incident management and support protocols (CIMSPs) have been developed to support them. This study describes the impact of CIs and evaluates the effectiveness of CIMSPs. METHODS: We interviewed 74 train drivers 1 week, 1, 3, and 6 months after a CI. We performed Linear growth model analyses to describe recovery paths and the effect of CIMSPs, considering the effect of CI complexity, proximity to victims, social support, self-assessment of health, use of resources, and attribution of responsibility. RESULTS: CIs have a significant negative impact on train drivers. Recovery paths can be explained by the level of implementation of CIMSPs, and other contributing factors. CONCLUSIONS: CIMSPs are effective in reducing the negative impact of CIs and should be implemented rigorously by employers.

Evaluation of the Implementation of a Railway Critical Incident Management and Support Protocol to Help Train Drivers Cope With Accidents and Suicides.

OBJECTIVE: Railway accidents and suicides can have severe psychological consequences for train drivers. This study evaluates the implementation of railway critical incident management and support protocols (CIMSP) by employers. It also identifies environmental factors, characteristics of critical incidents, and types of work relations affecting implementation. METHODS: A longitudinal study was conducted with 74 train drivers. Participants were interviewed 1 week, 1, 3, and 6 months after a critical incident. Correlational analyses were performed to identify factors associated with implementation and satisfaction. RESULTS: CIMSP are generally partially applied by employers when a railway incident occurs. Workers' satisfaction toward implementation of the protocol is moderate. Obstacles to implementation are: geographic isolation, severity of the incident, and poor quality of work relations. CONCLUSIONS: These obstacles should be addressed in CIMSP design and implementation strategies.

Reducing the impacts of exposure to potentially traumatic events on the mental health of public safety personnel: A rapid systematic scoping review.

Police, firefighters, and emergency medical technicians and paramedics are frequently exposed to potentially traumatic events (PTE) in their work as public safety personnel (PSP). PTE are a risk factor for posttraumatic stress disorder, depression, anxiety, substance abuse, and suicidal ideation. This systematic rapid scoping review summarizes evaluation research on psychosocial interventions to reduce the negative consequences of exposure to work-related PTE on the mental health of PSP. Articles were identified using PubMed and PsycInfo. Publications from January 1, 2013, to December 1, 2020, were retained because the research published before 2013 was covered by other reviews. We identified 601 unique documents; 30 met preliminary eligibility criteria; and 18 were retained. Most studies were limited to police officers and firefighters. Participants exposed to prevention measures reported improvements of symptoms of depression, burnout, anxiety, sleep problems, and well-being. Most articles identified factors that may hinder or facilitate the use of program components. Studies on ways to support PSP recently affected by a PTE are lacking. There are little data on the efficacy of prevention programs in reducing the prevalence of mental disorders associated with PTE. More studies should focus on identifying participant characteristics and intervention components that influence program use, adherence, and efficacy. Realistic evaluations combined with participatory research could help address important knowledge gaps. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Grief After Euthanasia and Physician-Assisted Suicide.

Background: Several countries have regulated euthanasia and physician-assisted suicide (PAS). Research has looked at the experiences of patients, family, and professionals. However, little is known of the effects on bereaved individuals. Aims: We aimed to assess (a) what is known about the grief and mental health of people bereaved by euthanasia or PAS and (b) the quality of the research. Method: Systematic review according to PRISMA guidelines with searches in Cinahl, Embase, PsycINFO, Pubmed, and Scopus. Results: The searches identified 10 articles (eight studies), and the study quality was fair. People bereaved by euthanasia/PAS generally had similar or lower scores on measures of disordered grief, mental health, and posttraumatic stress compared with those who died naturally. Lack of social support and secrecy may compound their grief. Being involved in the decision-making process and having the feeling of honoring the deceased's will may facilitate their grief. Limitations: Studies used self-reports from non-random self-selected participants, were retrospective, and were conducted in only three countries. Conclusion: There is little evidence of increased risk of adverse grief or mental health outcomes in people bereaved by euthanasia/PAS. As more countries legalize assisted dying, high-quality studies of the factors that may hinder or facilitate the grief process are needed.

Systematic comparison of recommendations for safe messaging about suicide in public communications.

BACKGROUND: The diversity of guidelines for safe public messaging about suicide and the heterogeneous scientific research on the topic warrants comparisons of guidelines and analysis of the relevance of research findings to determine best practices. METHODS: We searched databases and websites for organizations' guidelines concerning safe public messaging on suicide, and relevant research articles. RESULTS: We identified 24 public messaging guidelines, 11 terminology guidelines and 44 research papers. No recommendations were in all guidelines, with more agreement on what not to do than on what to do. Recommendations in over half of guidelines are: avoid glorifying suicide, do not describe suicide methods, don't say suicide in inexplicable or explain simplistically, do not state that suicide is frequent in specific circumstances, encourage help seeking. There were disagreements on including personal details about people who died by suicide, and agreement to avoid: "committed suicide," "completed suicide," "successful suicide," "failed suicide/attempt" "unsuccessful suicide/attempt". Only "died by suicide" was recommended by a majority. Some recommended and some said to avoid: "Suicide attempt," "attempt to end his life," "attempted suicide," "non-fatal attempt at suicide," "unintentional (death)," "intentional self-harm," "suicidal ideation," "completed suicide," "survivor," "suicide loss survivor." Research papers had a wide range of objectives, methodologies, media studied and target populations. None provided empirical data that could help support or refute any recommendations. LIMITATIONS: Lack of justifications for guidelines and scarce relevant research makes validation of recommendations challenging. CONCLUSIONS: Research is needed to validate recommendations and terminology and develop consensus on guidelines for public messages, and determine if media guidelines for reporting on suicide are relevant for public messaging who's goal is to inform and educate rather than report news.

Outcomes of Community-Based Suicide Prevention Approaches That Involve Reducing Access to Pesticides: A Systematic Literature Review.

OBJECTIVE: Pesticide ingestion is among the most commonly utilized means of suicide worldwide. Restricting access to pesticides at a local level is one strategy to address this major public health problem, but little is known about its effectiveness. We therefore conducted a systematic literature review to identify effective community-based suicide prevention approaches that involve restricting access to pesticides. METHOD: We searched Embase, Scopus, PsycINFO, Cochrane Library, CINAHL, and PubMed for well-designed studies that reported on suicide-related outcomes (i.e., attempted or completed suicide). RESULTS: We identified only five studies that met our eligibility criteria (two randomized controlled trials, two studies with quasi-experimental designs, and one study with a before-and-after design). These studies tested different interventions: the introduction of nonpesticide agricultural management, providing central storage facilities for pesticides, distributing locked storage containers to households, and local insecticide bans. The only sufficiently powered study produced no evidence of the effectiveness of providing household storage containers. Three interventions showed some promise in reducing pesticide suicides or attempts, with certain caveats. CONCLUSIONS: Our review identified three community interventions that show some promise for reducing pesticide suicides by restricting access to means, which will require replication in large, well-designed trials before they can be recommended.

Texting for Help: Processes and Impact of Text Counseling with Children and Youth with Suicide Ideation.

OBJECTIVE: To explore: (1) how children contacting a child helpline with suicide ideation differ from children discussing other topics, (2) whether text messaging effectively helps, and (3) which counselor behaviors are most effective. METHOD: Of 6,060 text sessions at the Danish national child helpline, 444 concerned suicidality, of which the 102 sessions that included self-rated, end Session ratings were selected for content analysis. RESULTS: Twenty-six percentage of suicidal children had severe suicidality. The suicide sample had significantly more girls, was older than the nonsuicide sample, and more often recontacted the helpline in the 2 weeks prior to follow-up. 35.9% of suicidal children felt better immediately and over half ended the session with a plan of action. At follow-up, 23.9% of suicidal children reported feeling better; however, 37.0% reported feeling worse. Talking about emotions, expressing empathy, and encouraging the child to talk to someone were associated with positive impacts. Setting boundaries was associated with negative impacts. CONCLUSIONS: Texting with suicidal children can be helpful, but should be considered a first step toward obtaining more sustainable help. Research is needed to determine how to better help children who felt worse or did not improve in the 2 weeks after contacting the helpline. Suggestions to further training of counselors are discussed.

The Darknet and suicide.

CONTEXT: The Internet contains both public content ("Surface Web"), and private content ("Deep Web") sometimes hosted on exclusive networks ("Darknets") only accessible using dedicated software such as TOR (The Onion Router). This software makes it almost impossible to identify its users. Information media have reported on suicide-related aspects of Darknets, for example when poisons that can be used to kill oneself are offered for sale (Le Garff et al., 2016) when users discuss ways to kill oneself in anonymous forums (Ferrara, 2016; Franceschi-Bicchierai, 2015) and suicides that follow bullying or "doxing" (online divulgation without consent of intimate personal information) (Bartlett, 2015). Several recent studies have analyzed the nature of suicide content on the Surface Web, but to date, there have been no systematic investigations of suicidal content available on Darknets. OBJECTIVES: The object was to document the nature and accessibility of suicide-related information available on the TOR Darknet or via the TOR software. METHODS: We replicated the methodology used by Biddle et al. (2008, 2016) in their studies of the Surface Web, using TOR on the Darknet. We identified and chose nine search engines used on the TOR Darknet: TORCH the TOR search engine, Notevil, Ahmia, Candle, Hidden Wiki, Darknet (onion.link), Duckduckgo and Grams. Two research assistants independently coded the first 30 results of searches using the keywords, "suicide" and "suicide methods". RESULTS: There were 476 "hits" in the search for "suicide" and "suicide method" using TOR, with fewer sites dedicated to suicide (4%), compared to the Surface Web (23.1%) (Biddle et al., 2016). Over half of the sites proposed by the TOR search engines (252, 52.9%) were outdated, inaccessible or not containing content pertinent to suicide or suicide methods. Several of the TOR search engines provided access to forums ("chat boards") where suicide was a topic (70, 14.8%). These were usually pro-suicide, are blocked or filtered by most of the Surface Web engines (e.g. Google). DISCUSSION: Persons concerned with suicide prevention should conduct further investigations of pro-suicide forums that are accessible using TOR and their users, comparing them with the Surface Web. New strategies to prevent suicide may need to be developed for Darknets.

Dyadic Adjustment Scale: a validation study among older French-Canadians living in relationships.

The principal objective of this study, the first of its kind to use this population, is to describe the factor analysis and validity of the Dyadic Adjustment Scale (EAD) among 895 French Canadian seniors living as couples. A confirmatory factor analysis was carried out using structural equation modeling. Results support Spanier's hierarchical model questionnaire (1976). Results also indicate evidence of validity and reliability satisfactorily set aside for the Affective Expression subscale having a lower Cronbach alpha coefficient. The results also indicate strong validity of the scale according to indices of convergent and discriminant validity. Finally, a discussion is presented addressing considerations to be taken into account for using the questionnaire among older couples.