Suicidal ideation, suicide plans and suicide attempts among Australian adults: Findings from the 2020-2022 National Study of Mental Health and Wellbeing.

OBJECTIVE: This study aimed to describe the epidemiology of suicidal ideation, suicide plans and suicide attempts, examine services received for suicide attempts, and explore the relationship between suicide attempts and self-harm without suicidal intent. METHODS: We used survey data from the 2020-2022 National Study of Mental Health and Wellbeing, which involved a nationally representative sample of Australian adults aged 16-85 (n = 15,893). Comparisons were made with the 2007 National Study of Mental Health and Wellbeing (n = 8841). RESULTS: In 2020-2022, the proportions of adults who had experienced suicidal ideation, suicide plans and suicide attempts during their lifetime were 16.6%, 7.5% and 4.9%, respectively. The proportions who had experienced these in the past 12 months were 3.3%, 1.1% and 0.3%. The odds of experiencing suicidal ideation and making a suicide plan were significantly higher in 2020-2022 than in 2007. Groups at heightened risk of suicidal ideation, suicide plans and/or suicide attempts in the previous 12 months were males, young people, people who were gay, lesbian, or bisexual or used some other term to describe their sexual identity, people outside the labour force, people from disadvantaged areas and people with mental disorders. Two-fifths of those who attempted suicide during the previous 12 months did not use health services following their attempt, and two-thirds also self-harmed without suicidal intent. CONCLUSION: The implications of these findings for the forthcoming National Suicide Prevention Strategy are discussed. Suicidal thoughts and behaviours confer risk for suicide and are significant problems in their own right. Their prevention requires a strong whole-of-government response.

Change in attitudes after a suicide prevention media campaign in the Mid-Norway region.

BACKGROUND: Suicide prevention media campaigns are one way of reaching people at increased suicide risk who would otherwise not seek help. This is the first study of a Norwegian campaign directed both at individuals at risk for suicide and at their social network. METHODS: We evaluated a media campaign consisting of outdoor posters, feature articles, film clips, and online banners in print, digital, and social media spread across the Mid-Norway region in late autumn 2022. This campaign material consisted of information about how to seek help for suicide thoughts and mental health problems and how to help a friend in similar situations. Before and after this campaign, 1149 adult individuals living in Mid-Norway participated in a survey on attitudes to suicide, mental ill health, and help-seeking. RESULTS: There were only marginal changes in attitudes and help-seeking literacy after the campaign. This result was sustained when controlling for age, sex, and campaign visibility. For males, there were a few changes in the negative direction, i.e. lack of willingness to seek help from family and friends, after the campaign. CONCLUSION: We conclude that the campaign did not seem to have the desired effect and suggest ways of improving future regional Norwegian media campaigns.

High-Risk Suicide Locations in Australia.

Importance: Although several interventions have been shown to be effective in preventing suicide at high-risk locations, the potential for these interventions to be deployed is limited by a lack of knowledge about where high-risk locations are and the factors associated with choosing these locations. Objective: To identify high-risk suicide locations in Australia and the factors associated with choosing these locations. Design, Setting, and Participants: This case-control study included data on individuals who died by suicide in Australia between January 2001 and December 2017, obtained from the National Coronial Information System. Data analysis was conducted from February to December 2021. Exposures: Sociodemographic, residential, incident time, and incident location variables. Main Outcomes and Measures: The scan statistic was used to detect spatial clusters of suicides in public locations. Suicide locations within significant clusters with at least 0.5 suicides per year were defined as high-risk locations. Multivariable logistic regression analyses were performed to examine the factors associated with choosing a high-risk location. Results: Over the study period, 10 701 suicides took place in public places. The individuals who died of suicide in public places included 8602 (80.4%) male individuals, and most were aged 25 to 49 years (5825 [54.5%]). A total of 17 high-risk suicide locations in Australia were detected. These involved 495 suicides, which accounted for 4.6% of suicides in public locations. For suicides at high-risk locations, 82.2% (407 of 495) occurred at cliffs and bridges. Being female (adjusted odds ratio [aOR], 1.73; 95% CI, 1.41-2.13), employed (aOR, 1.57; 95% CI, 1.20-2.04), never married (aOR, 1.64; 95% CI, 1.26-2.13), and from a major city (aOR, 3.94; 95% CI, 2.94-5.28) were associated with the choice of a high- over low-risk suicide location. High-risk locations tended to be in major cities. Conclusions and Relevance: This case-control study found 17 high-risk suicide locations in Australia and the factors associated with the choice of these locations. Actions should be taken to prevent suicide at these locations where possible.

Suicide prevention: reflections on progress over the past decade.

Interest in preventing suicides has increased greatly in recent years. In this Personal View, we consider the general global developments related to suicide prevention that have occurred in the decade since The Lancet Psychiatry was first published in 2014. We then review specific advances during this period, first, in relation to public health initiatives, and second, with regard to clinical developments. Finally, we examine some of the challenges that currently confront individuals and organisations responsible for designing and implementing suicide prevention measures.

Evaluating Population-Level Interventions and Exposures for Suicide Prevention.

Evaluations of interventions targeting the population level are an essential component of the policy development cycle. Pre-post designs are widespread in suicide prevention research but have several significant limitations. To inform future evaluations, our aim is to explore the three most frequently used approaches for assessing the association between population-level interventions or exposures and suicide - the pre-post design, the difference-in-difference design, and Poisson regression approaches. The pre-post design and the difference-in-difference design will only produce unbiased estimates of an association if there are no underlying time trends in the data and there is no additional confounding from other sources. Poisson regression approaches with covariates for time can control for underlying time trends as well as the effects of other confounding factors. Our recommendation is that the default position should be to model the effects of population-level interventions or exposures using regression methods that account for time effects. The other designs should be seen as fall-back positions when insufficient data are available to use methods that control for time effects.

Road vehicle collision suicide in Australia: Trends, collision types, and individual characteristics.

BACKGROUND: Suicide by road vehicle collision in Australia is under-explored with mixed findings. We aimed to address this research gap by examining time trends, different types of vehicle collision, and individual characteristics related to vehicle-collision suicide. METHOD: We retrospectively analyzed deaths by suicide between 1st January 2001 and 31st December 2017 in Australia, using coronial records from the National Coronial Information System. The travel mode used and collision counterpart were retrieved from records of death by vehicle-collision suicide using all available information. We conducted negative binomial regression analysis to examine annual changes in suicide rate by vehicle collision on a public road (N = 640) and other methods of suicide (N = 41,890), and logistic regression analysis to examine individual characteristics associated with the likelihood of dying by suicide via road vehicle collision. RESULTS: Overall, the national suicide rate involving road vehicle collision significantly increased, while the rate by other methods significantly decreased. Drivers accounted for 61% of suicide events by vehicle collision, of which 72% were single-vehicle collisions (commonly involving a tree). For multiple-vehicle collision suicide events, 82% involved collision with a truck. Pedestrians accounted for more than one-third of suicide events, of which 58% involved collision with a truck and 23% involved collision with a car/van. Individuals who were male (odds ratio 1.15; 95% CI 0.88-1.50), aged <25 years old (odds ratio 5.27; 95% CI 3.05-9.10), non-Indigenous (odds ratio 3.36; 95% CI 1.71-6.62), and born overseas (odds ratio 1.40; 95% CI 1.10-1.79) were more likely to die by vehicle-collision suicide than by other methods of suicide. CONCLUSIONS: This study provides a better understanding of road vehicle collision suicide in Australia and informs future research directions on topic. Our findings can be used to inform suicide prevention initiatives to reduce vehicle-collision suicide deaths.

Suicide within five years of hospital-treated self-harm: A data linkage cohort study.

BACKGROUND: Hospital-treated self-harm is a strong predictor of suicide and hospital contacts may include missed opportunities for suicide prevention. We conducted a data linkage study to identify factors associated with suicide in people treated in hospital for self-harm in Victoria, Australia. METHOD: We undertook a cohort study following 14,307 people treated in hospital for an episode of self-harm (i.e., either admitted or non-admitted ED presentations) over the period 2011 and 2012 and used data from the Victorian Suicide Register to identify suicides within 5 years. We estimated unadjusted hazard ratios (HRs) for suicide using survival analysis for each exposure variable and then computed adjusted HRs using a multivariate model that included all exposure variables. RESULTS: Among females, the risk of suicide was higher in those aged 50-74 years (HR 1.78; Cl: 1.02, 3.10), residing in areas of least disadvantage (HR 2.58; Cl: 1.21, 5.50), who used hanging as a method of self-harm (HR 5.17; Cl: 1.86, 14.35) and with organic disorders (HR 6.71; Cl: 2.61, 17.23) or disorders of adult personality and behaviour (HR 2.10; Cl: 1.03, 4.27). In males, the risk of suicide was higher in those who used motor vehicle exhaust gas (MVEG) as a method of self-harm (HR 3.48; Cl: 1.73, 7.01), and with disorders due to psychoactive substance abuse (HR 1.75; Cl: 1.14, 2.67). CONCLUSION: Although all patients should be routinely assessed for risk and needs following hospital-treated self-harm including appropriate follow-up care, people who use MVEG or hanging as methods of self-harm are obvious candidates for close follow-up.

A longitudinal study of the impacts of a stay in a Prevention and Recovery Care service in Victoria, Australia.

BACKGROUND: Prevention and Recovery Care services are residential sub-acute services in Victoria, Australia, guided by a commitment to recovery-oriented practice. The evidence regarding the effectiveness of this service model is limited, largely relying on small, localised evaluations. This study involved a state-wide investigation into the personal recovery, perceived needs for care, well-being and quality-of-life outcomes experienced by Prevention and Recovery Care services' consumers. METHODS: A longitudinal cohort design examined the trajectory of self-reported personal recovery and other outcomes for consumers in 19 Victorian Prevention and Recovery Care services over 4 time points (T1 - 1 week after admission; T2 - within 1 week of discharge; T3 - 6 months after discharge; T4 - 12 months after discharge). T2-T4 time frames were extended by approximately 3 weeks due to recruitment challenges. The Questionnaire about the Process of Recovery was the primary outcome measure. RESULTS: At T1, 298 consumers were recruited. By T4, 114 remained in the study. Participants scored higher on the Questionnaire about the Process of Recovery at all three time points after T1. There were also sustained improvements on all secondary outcome measures. Improvements were then sustained at each subsequent post-intervention time point. Community inclusion and having needs for care met also improved. CONCLUSION: The findings provide a consistent picture of benefits for consumers using Prevention and Recovery Care services, with significant improvement in personal recovery, quality of life, mental health and well-being following an admission to a Prevention and Recovery Care service. Further attention needs to be given to how to sustain the gains made through a Prevention and Recovery Care service admission in the long term.

Supporting Adolescents Bereaved by Suicide or Other Traumatic Death: The Views of Counselors.

Adolescents bereaved by suicide and other traumatic death may experience strong grief reactions and increased risks of mental health problems and suicidal behaviour. As timely access to professional help can be critical, it is essential to understand how counselors perceive suicide bereavement in adolescents and how they work with this population. This study aimed to examine the perspectives of counselors (N = 34). Eleven participated in an individual semi-structured interview and 23 others in group interviews. Thematic analysis yielded three themes: (1) Building a relationship with the bereaved adolescent, (2) Offering support tailored to the needs of the grieving adolescent, and (3) Offering strengths-based and sustainable support. Counselors' skills, attitudes, content-related expertise, and approaching the adolescent's grief within their developmental context were deemed essential for building a therapeutic relationship and offering viable support. The findings may inform good practices in counseling bereaved adolescents to facilitate positive mental health outcomes.

Indonesia's first suicide statistics profile: an analysis of suicide and attempt rates, underreporting, geographic distribution, gender, method, and rurality.

Background: Timely and accurate data are critical for effective suicide prevention. Indonesia-the fourth most populous country in the world-has limited data availability and thus, limited data-driven interventions. Through a national government partnership, we obtained critical non-public data for attempts and suicides that could be analysed for the first time in Indonesia's history. Methods: We obtained and analysed data from five sources from 2016 to 2021: police data, death registry data, a provincial survey, a sample registry system, and the WHO's Global Health Observatory (WHO GHO) data. Using these data, we estimated underreporting, identified provinces with the highest suicide and suicide attempt rates, assessed gender ratios, identified methods used, and compared urban and rural suicides. Findings: The analysis yielded an underreporting rate of 859.10% for suicides, while verbal autopsies and increased quality control only increased coverage from 12.80% to 51.40%. Provinces with the highest rates of suicide were Bali, Riau Islands, Special Region of Yogyakarta, Central Java, and Central Kalimantan. Gender analysis revealed a ratio of 1: 2.11 for female to male suicides. Suicide methods analysis revealed that hanging and self-poisoning were the most used method, and rural suicides occurred at a rate 4.47 times higher than urban suicides. Interpretation: The analysis revealed the highest underreporting rate in the literature from a national sample and vast heterogeneity among provinces with high suicide rates-including provinces with strong mystic beliefs, suggesting the need for a culturally sensitive sub-national tailored approach. Through our study, we provide critical information which will allow for data-driven suicide prevention. Funding: The data collection for this was part of a project funded by the Australian Department of Foreign Affairs and Trade, Australian-Indonesian Institute (AII2020322).

Changes in Media Reporting Quality and Suicides Following National Media Engagement on Responsible Reporting of Suicide in Canada: Changements de la Qualité des reportages dans les médias sur les suicides suite à l'engagement des médias nationaux à la déclaration responsable du suicide au Canada.

OBJECTIVE: Responsible media reporting is an accepted strategy for preventing suicide. In 2015, suicide prevention experts launched a media engagement initiative aimed at improving suicide-related reporting in Canada; its impact on media reporting quality and suicide deaths is unknown. METHOD: This pre-post observational study examined changes in reporting characteristics in a random sample of suicide-related articles from major publications in the Greater Toronto Area (GTA) media market. Articles (n = 900) included 450 from the 6-year periods prior to and after the initiative began. We also examined changes in suicide counts in the GTA between these epochs. We used chi-square tests to analyse changes in reporting characteristics and time-series analyses to identify changes in suicide counts. Secondary outcomes focused on guidelines developed by media professionals in Canada and how they may have influenced media reporting quality as well as on the overarching narrative of media articles during the most recent years of available data. RESULTS: Across-the-board improvement was observed in suicide-related reporting with substantial reductions in many elements of putatively harmful content and substantial increases in all aspects of putatively protective content. However, overarching article narratives remained potentially harmful with 55.2% of articles telling the story of someone's death and 20.8% presenting an other negative message. Only 3.6% of articles told a story of survival. After controlling for potential confounders, a nonsignificant numeric decrease in suicide counts was identified after initiative implementation (ω = -5.41, SE = 3.43, t = 1.58, p = 0.12). CONCLUSIONS: We found evidence that a strategy to engage media in Canada changed the content of reporting, but there was only a nonsignificant trend towards fewer suicides. A more fundamental change in media narratives to focus on survival rather than death appears warranted.

The Cost-Effectiveness of Psychosocial Interventions Following Self-Harm in Australia.

Background: Psychosocial interventions following self-harm in adults, in particular cognitive behavioral therapy (CBT), can be effective in lowering the risk of repeated self-harm. Aims: To evaluate the cost-effectiveness of CBT for reducing repeated self-harm in the Australian context. Method: The current study adopted the accessing cost-effectiveness (ACE) approach using return-on-investment (ROI) analysis. Uncertainty and sensitivity analyses (Sas) tested the robustness of the model outputs to changes in three assumptions: general practitioner referral pathway (SA1), private setting intervention delivery (SA2), and training costs (SA3). Results: The intervention produced cost savings of A$ 46M (95% UI -223.7 to 73.3) and A$ 18.3M (95% UI -86.2 to 24.6), subject to the effect of intervention lasting 2- or 1-year follow-up. The ROI ratio reduced to 5.22 in SA1 (95% UI -10.1 to 27.9), 2.5 in SA2 (95% UI -4.8 to 13.3), and 5.1 in SA3 (95% UI -9.8 to 27.8). Limitations: We assumed that the effectiveness would reduce 50% within 5 years in the base case, and we used Australian data and a partial social perspective. Conclusions: The current study demonstrated cost-effectiveness of CBT for adults who have self-harmed with the return-on-investment ratio of A$ 2.3 to $6.0 for every A$ 1 invested.

A randomized wait-list controlled trial of Men in Mind: Enhancing mental health practitioners' self-rated clinical competencies to work with men.

Improved engagement of men in psychotherapy is an essential element in improving male health outcomes. This trial examined whether the Men in Mind intervention improved practitioners' self-rated clinical competencies to engage and respond to male clients in therapy. A parallel, single-blind, wait-list randomized controlled trial was conducted with Australian-based mental health practitioners, currently administering psychotherapy to males, fluent in English, and not currently completing their undergraduate degree. Participants were randomly assigned 1:1, through variable-sized blocks stratified by gender, to either the intervention (Men in Mind) or wait-list control. Men in Mind was offered as a self-led 6-week, five-module online program to upskill practitioners to engage and respond to male clients. The primary outcome was self-reported competency in engaging men in psychotherapy, measured by the Engaging Men in Therapy Scale (EMITS) at 6 weeks. All analyses were by intention-to-treat. Between January 16 and March 17, 2022, 587 participants were randomly assigned to the intervention (n = 300) or wait-list control (n = 287). In total, 492 (84%) participants completed the primary endpoint assessment at 6 weeks. Men in Mind demonstrated a large effect of improved EMITS scores compared to the control group (d = 2.63, 95% CI [2.39, 2.87], p < .001). Men in Mind was effective at increasing mental health practitioners' self-reported efficacy to work with men, which is potentially a key change mechanism in their ability to improve health outcomes for male clients. A limitation of the trial was the use of a bespoke, self-reported primary outcome, while a strength was the gender-responsive intervention design. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An Evaluation of the Boys Do Cry Suicide Prevention Media Campaign on Twitter: Mixed Methods Approach.

BACKGROUND: In most countries, men are more likely to die by suicide than women. Adherence to dominant masculine norms, such as being self-reliant, is linked to suicide in men in Western cultures. We created a suicide prevention media campaign, "Boys Do Cry," designed to challenge the "self-reliance" norm and encourage help-seeking in men. A music video was at the core of the campaign, which was an adapted version of the "Boys Don't Cry" song from "The Cure." There is evidence that suicide prevention media campaigns can encourage help-seeking for mental health difficulties. OBJECTIVE: We aimed to explore the reach, engagement, and themes of discussion prompted by the Boys Do Cry campaign on Twitter. METHODS: We used Twitter analytics data to investigate the reach and engagement of the Boys Do Cry campaign, including analyzing the characteristics of tweets posted by the campaign's hosts. Throughout the campaign and immediately after, we also used Twitter data derived from the Twitter Application Programming Interface to analyze the tweeting patterns of users related to the campaign. In addition, we qualitatively analyzed the content of Boys Do Cry-related tweets during the campaign period. RESULTS: During the campaign, Twitter users saw the tweets posted by the hosts of the campaign a total of 140,650 times and engaged with its content a total of 4477 times. The 10 highest-performing tweets by the campaign hosts involved either a video or an image. Among the 10 highest-performing tweets, the first was one that included the campaign's core video; the second was a screenshot of the tweet posted by Robert Smith, the lead singer of The Cure, sharing the Boys Do Cry campaign's video and tagging the campaign's hosts. In addition, the pattern of Twitter activity for the campaign-related tweets was considerably higher during the campaign than in the immediate postcampaign period, with half of the activity occurring during the first week of the campaign when Robert Smith promoted the campaign. Some of the key topics of discussions prompted by the Boys Do Cry campaign on Twitter involved users supporting the campaign; referencing the original song, band, or lead singer; reiterating the campaign's messages; and having emotional responses to the campaign. CONCLUSIONS: This study demonstrates that a brief media campaign such as Boys Do Cry can achieve good reach and engagement and can prompt discussions on Twitter about masculinity and suicide. Such discussions may lead to greater awareness about the importance of seeking help and providing support to those with mental health difficulties. However, this study suggests that longer, more intensive campaigns may be needed in order to amplify and sustain these results.

#chatsafe 2.0. updated guidelines to support young people to communicate safely online about self-harm and suicide: A Delphi expert consensus study.

INTRODUCTION: Young people use social media to communicate about self-harm and suicide and this is associated with both potential risks and protective effects. The #chatsafe guidelines were originally developed in 2018 to equip young people to communicate safely online about suicide. They were shown to be safe, acceptable, and beneficial; however, they do not provide guidance on self-harm, and social media is constantly evolving. This study aimed to update the #chatsafe guidelines to reflect new evidence and current social media affordances, and to include guidance on self-harm. METHODS: A Delphi expert consensus study was conducted, comprising six stages: 1) A systematic search of peer-reviewed and grey literature; 2) A series of roundtables with key stakeholders including social media companies, policymakers, and young people; 3) Questionnaire development; 4) Expert panel formation; 5) Data collection and analysis; and 6) Guideline development. RESULTS: A total of 191 items were included in the new #chatsafe guidelines. These were organised into eight themes, which became the overarching sections of the guidelines: 1) General tips; 2) Creating self-harm and suicide content; 3) Consuming self-harm and suicide content; 4) Livestreams of self-harm and suicide acts; 4) Self-harm and suicide games, pacts, and hoaxes; 6) Self-harm and suicide communities; 7) Bereavement and communicating about someone who has died by suicide; and 8) Guidance for influencers. DISCUSSION: The new guidelines include updated and new information on online communication about self-harm, livestreams, games, pacts, and hoaxes, as well as guidance for influencers. They will be disseminated via a national social media campaign and supported by a series of adult-facing resources. Given the acceptability of the original guidelines and the ubiquitous use of social media by young people, it is hoped that the new guidelines will be a useful resource for young people and adults alike, both in Australia and worldwide.

Modelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm.

BACKGROUND: Prior self-harm represents the most significant risk factor for future self-harm or suicide. AIM: To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context. METHOD: We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost-utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted. RESULTS: The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: -56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: -0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses. CONCLUSIONS: A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.

Will a fee-for-service payment for a young people's health assessment in general practice increase the detection of health risk behaviours and health conditions? Protocol for a cluster randomised controlled trial (RAd Health Trial).

INTRODUCTION: Adolescence is a period of major transition in physical, cognitive, social and emotional development, and the peak time for the onset of mental health conditions, substance use disorders and sexual and reproductive health risks. Prevention and treatment during this time can improve health and well-being now and into the future. However, despite clinical guidelines recommending annual preventive health assessments for young people, health professionals cite lack of consultation time and adequate funding as key barriers. This trial aims to determine whether a specific fee-for-service ('rebate payment') for a young person's health assessment, is effective and cost-effective at increasing the detection and management of health risk behaviours and conditions among young people. METHODS AND ANALYSIS: This cluster randomised controlled trial will be conducted in Australian general practice. 42 general practices (clusters) will be randomly allocated 1:1 to either an intervention arm where general practitioners receive a rebate payment for each annual health assessment undertaken for 14-24-year-olds during a 2 year study period, or a control arm (no rebate). The rebate amount will be based on the Medical Benefits Schedule (Australia's list of health professional services subsidised by the Australian Government) currently available for similar age-based assessments. Our primary outcome will be the annual rate of risk behaviours and health conditions recorded in the patient electronic health record (eg, alcohol/drug use, sexual activity and mental health issues). Secondary outcomes include the annual rate of patient management activities related to health risks and conditions identified (eg, contraception prescribed, sexually transmitted infection tests ordered). A process evaluation will assess acceptability, adoption, fidelity and sustainability of the rebate; an economic evaluation will assess its cost-effectiveness. Analyses will be intention-to-treat. ETHICS AND DISSEMINATION: Ethics approval has been obtained from University of Melbourne Human and Research Ethics Committee (2022-23435-29990-3). Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12622000114741.

Changing profile of suicide methods in India: 2014-2021.

BACKGROUND: Restricting access to suicide methods is one of the most effective suicide prevention approaches. METHODS: Trends in method specific suicide rates (2014-2021) in India were calculated using National Crime Records Bureau data (NCRB) by sex and geographical region. Joinpoint regression analysis was used to empirically identify any changes in suicide trends. RESULTS: Suicide rates by hanging increased from 6.08 to 10.0 per 100,000 population among males and from 2.55 to 3.56 per 100,000 among females over the study period. Insecticide poisoning suicide rates also increased from 1.51 to 2.73 per 100,000 among males and from 0.74 to 1.14 per 100,000 among females. Suicide by self-immolation decreased over the study period among both sexes. In general, these national trends were mirrored among different regions. Joinpoint regression indicated an increase in suicide by hanging (annual percentage change (APC) of 12.3 among males between 2018 and 2021 and 4.9 among females between 2014 and 2021) and an increase in male suicide by insecticide poisoning between 2014 and 2021 (APC of 4.2) while a decrease in self-immolation rates was noted among males (APC of -12.7 between 2014 and 2021) and females (APC of -16.5 between 2016 and 2021). LIMITATION: The NCRB data might underestimate true suicide rates. CONCLUSION: Hanging suicides and insecticides poisoning suicides observed an increasing trend between 2014 and 2021. Self-immolation rates decreased during the study period which might be, in part, associated with the initiative to provide clean cooking fuel to households. Ban on lethal pesticides must be prioritised which might help lower insecticide poisoning suicide rates.