The impact of trauma-informed suicide prevention approaches: A systematic review of evidence across the lifespan.

Trauma is associated with an increased likelihood of experiencing suicidality, indicating the need for and potential value of trauma-informed suicide prevention strategies. The aim of this study is to systematically review published literature regarding trauma-informed approaches for suicide prevention, and the impact on suicide outcomes. Systematic searches were conducted in eight databases (Medline, Embase, PsycInfo, Emcare, Nursing, and JBI in the Ovid platform; as well as ProQuest Psychology Database and The Cochrane Library) in March 2022, with no publication date limit. Four studies met the inclusion criteria: two randomized controlled trials and two quasi-experimental studies. Two studies reported reductions in ideation, intent, and behaviour among youth and a cultural minority group. Few studies directly reporting suicide outcomes were identified, all were quantitative, and heterogeneity prevents generalizability across population groups. Currently, there is limited evidence focusing specifically on trauma-informed suicide prevention across the lifespan. Additional research, incorporating lived experience voices, is needed to understand the potential of this approach, as well as how mental health nurses can incorporate these approaches into their practice.

An Evaluation of Suicide Prevention Education for People Working With Refugees and Asylum Seekers.

Background: There are concerning rates of suicidality among asylum seekers and refugees in Australia, and tailored suicide prevention initiatives are needed. Aims: We aimed to evaluate the impact of a tailored suicide prevention education program for people working with asylum seekers and refugees. Method: Attendees of the education program completed self-report questionnaires at pretraining, posttraining, and 4-6 months follow-up. Results: Over 400 workers, volunteers, and students across Australia took part in the education program. A series of linear mixed-effects models revealed significant improvements in outcome measures from pretraining (n = 247) to posttraining (n = 231). Improvements were maintained at follow-up (n = 75). Limitations: Limitations of this research were the lack of a control group and a low follow-up response rate. Conclusion: Findings suggest that a 2 days tailored suicide prevention education program contributes to significant improvements in workers' attitudes toward suicide prevention, and their confidence and competence in assessing and responding to suicidal distress.

Staff Perspectives of Safety Planning as a Suicide Prevention Intervention for People of Refugee and Asylum-Seeker Background.

Background: Safety planning involves the co-development of a personalized list of coping strategies to prevent a suicide crisis. Aims: We explored the perspectives of workers regarding safety planning as a suicide prevention strategy for people of refugee background and those seeking asylum in Australia. Method: Participants attended suicide prevention training, specific to refugees and asylum seekers, at which safety planning was a key component. Semistructured, posttraining interviews (n = 12) were analyzed thematically. Results: Four key themes were identified: safety planning as a co-created, personalized activity for the client; therapeutic benefits of developing a safety plan; barriers to engaging in safety planning; strategies to enhance safety planning engagement. Limitations: First-hand refugee and asylum-seeker experiences were not included. Conclusion: As a relatively low-cost, flexible intervention, safety planning may be valuable and effective for these groups.

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review.

The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI.HighlightsThe Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings.Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).

The impact of suicide prevention education programmes for nursing students: A systematic review.

The purpose of this systematic review was to locate and synthesize peer-reviewed evidence regarding the effectiveness of providing suicide prevention education to nursing students. Systematic searches were conducted in seven databases (EMBASE, EmCare, Joanna Briggs, MEDLINE, PsycINFO, Scopus, and Web of Science). Results were screened in duplicate at two stages: title and abstract, and full text. Critical appraisal and data extraction were also completed in duplicate. Initial database searching yielded 303 results. Following the addition of seven records from relevant reference lists, and the removal of duplicates, a total of 118 results were included for screening. Eight articles were deemed eligible for inclusion in this review; most (n = 5) were quantitative. While all were conducted within university settings, half were stand-alone education sessions, while the remaining were integrated with existing programmes/courses. The types of education programmes varied considerably across studies, with only three being established, evidence-based programmes. The studies explore a range of outcomes, which have been narratively categorized as enhanced skills, abilities, and self-confidence; development of positive attitudes and beliefs; acquisition of knowledge; and programme experience and evaluation. While there is a small body of evidence indicating that suicide prevention education programmes contribute to improvements in skills, abilities, self-confidence, and attitudes among nursing students, the variability in educational interventions and outcomes, coupled with short-term evaluation time frames, makes it difficult to fully understand the impact of this important suicide prevention strategy.

Development of an evidence-based Evaluation Toolkit for suicide prevention networks in regional Australia.

PROBLEM: Suicide is a global public health concern, particularly for those living in rural, regional and remote areas. Despite numerous prevention initiatives, suicide continues to impact individuals, families and communities. Suicide prevention networks are an innovative, community-based approach to addressing suicide within local government areas. Anecdotally, suicide prevention networks make an important contribution to suicide prevention, yet frameworks for evaluating their impact do not exist. The purpose of this project was to develop an Evaluation Toolkit to be used by suicide prevention networks throughout South Australia to monitor their impact. DESIGN: Participatory action research was used to work with one suicide prevention network in regional South Australia to co-design and produce the Evaluation Toolkit. SETTING: One regional South Australian town, with an established suicide prevention network. KEY MEASURES FOR IMPROVEMENT: The development of an Evaluation Toolkit, to allow all South Australian suicide prevention networks to measure their impact in a consistent manner. STRATEGIES FOR CHANGE: The Evaluation Toolkit has been made freely available in electronic form and as a hard copy booklet for use by all South Australian suicide prevention networks. EFFECTS OF CHANGE: The purpose of this project was to develop the Evaluation Toolkit. Formal assessment of its usability and effectiveness is yet to be undertaken, but preliminary anecdotal evidence indicates aspects of the Evaluation Toolkit are useful, especially the questionnaire templates that can be adapted and used to evaluate various community events. LESSONS LEARNT: Participatory action research is a useful method for working with community-based suicide prevention groups.

Suicide Prevention Training - Improving the Attitudes and Confidence of Rural Australian Health and Human Service Professionals.

BACKGROUND: Suicide rates are higher in rural and remote areas of Australia compared with major cities. AIM: To evaluate the impact of a brief, community-based suicide prevention educational intervention on the attitudes and confidence of rural South Australian health and human service professionals. METHOD: Participants attended a 1-day suicide prevention education program, and completed a survey at four time points: baseline (T1), immediately pretraining (T2), immediately posttraining (T3), and 4-month follow-up (T4). Main outcome measures were self-reported attitudes and confidence when working with people vulnerable to suicide. RESULTS: A total of 248 people attended the training, with 213 participants completing the survey at T1, 236 at T2, 215 at T3, and 172 at T4. There were significant improvements in 11 of the 14 attitude items between T2 and T3 (immediate change), and between T1 and T4 (maintained change). Further, there were significant improvements in all four confidence items between T2 and T3, and T1 and T4. LIMITATIONS: Despite the repeated-measures design, findings are limited by the lack of a control group. CONCLUSION: Findings extend the international evidence by indicating the value of brief suicide prevention education for improving health and human service professionals' attitudes and confidence in rural Australia.

Enablers of psychological well-being for refugees and asylum seekers living in transitional countries: A systematic review.

The purpose of this systematic review was to locate and synthesise existing peer-reviewed quantitative and qualitative evidence regarding enablers of psychological well-being among refugees and asylum seekers living in transitional countries and for whom migration status is not final. Systematic searches were conducted in nine databases: Academic Search Premier, CINAHL, Embase, Emcare, Medline, Psychology and Behavioral Science, PsycINFO, Scopus, and Web of Science. Search terms were related to refugees and asylum seekers, enablers, and psychological well-being. Studies were limited to those conducted in the last 20 years, with participants who were refugees and asylum seekers with no legal residency status, aged 16 years and above, and living in transit host countries without UNHCR resettlement programmes. This systematic review was conducted between March and June 2018 and followed the PRISMA guidelines. Results were screened by two reviewers at two stages: title and abstracts, and full-text. Critical appraisal and data extraction were also completed by two reviewers. Initial database searching yielded 3,133 results. Following the addition of two records from relevant reference lists and the removal of duplicates, a total of 1,624 results were included for screening. A total of 16 articles were deemed eligible for inclusion in this review, reporting on a collective sample of 1,352 participants. Twelve qualitative and four quantitative studies identified eight enablers of psychological well-being: social support; faith, religion and spirituality; cognitive strategies; education and training opportunities; employment and economic activities; behavioural strategies; political advocacy; and environmental conditions. Despite many challenges associated with forced displacement and the transit period, this review highlights multiple factors that promote well-being and suggest areas for intervention development and resource allocation.

Perspectives of rural health and human service practitioners following suicide prevention training programme in Australia: A thematic analysis.

There are well-established training programmes available to support health and human services professionals working with people vulnerable to suicide. However, little is known about involving people with lived experience in the delivery of suicide prevention training with communities with increased rates of suicide. The aim of this paper was to report on a formative dialogical evaluation that explored the views of health and human services workers with regard to a suicide prevention training programme in regional (including rural and remote areas) South Australia which included meaningful involvement of a person with lived experience in the development and delivery of the training. In 2015, eight suicide prevention training workshops were conducted with health and human services workers. All 248 participants lived and worked in South Australian regional communities. We interviewed a subsample of 24 participants across eight sites. A thematic analysis of the interviews identified five themes: Coproduction is key, It is okay to ask the question, Caring for my community, I can make a difference and Learning for future training. The overall meta-theme was "Involvement of a person with lived experience in suicide prevention training supports regional communities to look out for people at risk of suicide." This paper highlights the need for suicide prevention training and other workforce development programmes to include lived experience participation as a core component in development and delivery.

The Effectiveness of Suicide Prevention Education Programs for Nurses.

BACKGROUND: Education to improve health professionals' responses to suicide is considered an important suicide prevention strategy. However, the effectiveness of this approach for nurses is unclear. AIM: To systematically review the peer-reviewed literature regarding the effectiveness of suicide prevention education programs for nurses. METHOD: Nine academic databases (CINAHL, Cochrane Reviews & Trials, Embase, Informit Health Collection, Joanna Briggs Institute, Medline, PsycINFO, Scopus, and Web of Science) were searched in November 2016, utilizing search terms related to suicide, education, and nurses, with no limits placed on publication date or study design. RESULTS: The search yielded 5,456 identified articles, 11 of which met the inclusion criteria. Studies were primarily quantitative (RCTs n = 3; quasi-experimental n = 6; qualitative n = 2), and involved nurses (range = 16-561) working in a diversity of settings, particularly hospitals (n = 9). Studies revealed positive changes in nurses' competence, knowledge, and attitudes associated with training over the short term. LIMITATIONS: The heterogeneity of education programs and methodological weaknesses of included studies limit the conclusions drawn. CONCLUSION: There is a moderate body of evidence to support the effectiveness of suicide prevention education programs for nurses. Future research should examine longer-term changes in clinical practice and strategies for continuing education, with more rigorous study designs.

Physical activity predicts quality of life and happiness in children and adolescents with cerebral palsy.

PURPOSE: To examine the associations between physical activity, health-related quality of life and happiness in young people with cerebral palsy. METHOD: A total of 70 young people with cerebral palsy (45 males, 25 females; mean age 13 years 11 months, SD 2 years 0 month) took part in a cross-sectional, descriptive postal survey assessing physical activity (Physical Activity Questionnaire for Adolescents), functional ability (Gross Motor Function Classification System), quality of life (Pediatric Quality of Life Inventory 4.0) and happiness (single Likert-scale item). Relationships between physical activity, quality of life and happiness were examined using backward stepwise linear regression. RESULTS: Physical activity significantly predicted physical quality of life (R(2 )= 0.64, ß = 6.12, p = 0.02), social quality of life (R(2 )= 0.28, ß = 9.27, p < 0.01) and happiness (R(2 )= 0.08, ß = 0.9, p = 0.04). Physical activity was not associated with emotional or school quality of life. CONCLUSIONS: This study found a positive association between physical activity, social and physical quality of life, and happiness in young people with cerebral palsy. Findings underscore the potential benefits of physical activity for the wellbeing of young people with cerebral palsy, in addition to its well-recognised physical and health benefits. IMPLICATIONS FOR REHABILITATION: Physical activity is a key predictor of quality of life and happiness in young people with cerebral palsy. Physical activity is widely recognised as having physical health benefits for young people with cerebral palsy; however, this study also highlights that it may have important benefits for wellbeing, quality of life and happiness. This emphasises the need for clinical services and intervention studies aimed specifically at increasing physical activity amongst children and adolescents with cerebral palsy.

Engaging with culturally and linguistically diverse communities to reduce the impact of depression and anxiety: a narrative review.

Culturally and linguistically diverse (CALD) communities in Australia face significant challenges in terms of reducing barriers to information and support for depression and anxiety. Increased stigma surrounding mental ill-health in some cultures and related concerns about trust and confidentiality all impact upon timely access to information, services and support for consumers and carers from CALD backgrounds. For health services, there is a need to understand how to better engage CALD communities in mental healthcare. The objective of this narrative review was to identify examples of evidence-based, best practice for what works effectively for engaging with CALD communities to reduce the impact of depression and anxiety. In January 2014, we searched Academic Search Premier, CINAHL, Health-Source Consumer Edition, PsycARTICLES, PsycINFO (all databases within the EbscoHost platform) and PubMed for peer-reviewed articles published between 1994 and 2014. The search revealed a total of 706 records contained within the EbscoHost platform and 689 records in PubMed; 15 matched the inclusion criteria. Six key themes were identified: (i) setting the scene for engagement; (ii) cultural values and preferences; (iii) language considerations; (iv) 'engagers' in the therapeutic process; (v) opening out engagement to include others; and (vi) engaging through the use of technology and alternative mediums. The literature obtained provides a small body of evidence regarding approaches to engaging CALD communities, with findings highlighting the importance of processes which are tailored to the CALD community of interest and which take into account different cultural explanatory models of mental ill-health. Review findings are also discussed within the framework of intersectionality, in which broader structural inequalities and power imbalances - in areas such as gender and social class - collectively impact on help-seeking and mental health outcomes. This review supports further enquiry into how such societal issues influence engagement - and disengagement - in mental health services for CALD communities.

Face to face, person to person: Skills and attributes deployed by rural mental health clinicians when engaging with consumers.

OBJECTIVE: The purpose of this study was to identify the skills and attributes deployed by rural mental health clinicians when engaging with consumers in the community mental health context. DESIGN: Reflecting the exploratory nature of this research, a semi-structured focus group was conducted. SETTING: One community mental health service in regional South Australia (catchment area = approximately 60 000 people). PARTICIPANTS: Nine mental health clinicians. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants' focus group comments were explored qualitatively using thematic analysis. RESULTS: Three major themes were identified: (i) limitations to providing mental health care in the rural environment (increased consumer vulnerability, limited services, increased risk, and stigma); (ii) universal engagement approaches (being consumer-focused, appropriate communication, facilitating a connection and normalising the experience); (iii) indicated and targeted strategies for engagement (flexible and creative delivery of care, a whole of community approach, being multiskilled and technology use). CONCLUSIONS: Although engaging with consumers involves many skills and attributes employed universally across mental health settings, the rural clinician's ability to navigate the environment and utilise this to provide consumer care is equally important to the engagement process. Specifically, these findings highlight the preference of rural mental health clinicians towards a person-centred approach, networking with others in the community when providing care. Understanding how best to maximise the nature of a rural environment, such as facilitating relationships between clinicians and others in the community, will contribute to optimised care.

A Web-Based, Social Networking Physical Activity Intervention for Insufficiently Active Adults Delivered via Facebook App: Randomized Controlled Trial.

BACKGROUND: Online social networks offer considerable potential for delivery of socially influential health behavior change interventions. OBJECTIVE: To determine the efficacy, engagement, and feasibility of an online social networking physical activity intervention with pedometers delivered via Facebook app. METHODS: A total of 110 adults with a mean age of 35.6 years (SD 12.4) were recruited online in teams of 3 to 8 friends. Teams were randomly allocated to receive access to a 50-day online social networking physical activity intervention which included self-monitoring, social elements, and pedometers ("Active Team" Facebook app; n=51 individuals, 12 teams) or a wait-listed control condition (n=59 individuals, 13 teams). Assessments were undertaken online at baseline, 8 weeks, and 20 weeks. The primary outcome measure was self-reported weekly moderate-to-vigorous physical activity (MVPA). Secondary outcomes were weekly walking, vigorous physical activity time, moderate physical activity time, overall quality of life, and mental health quality of life. Analyses were undertaken using random-effects mixed modeling, accounting for potential clustering at the team level. Usage statistics were reported descriptively to determine engagement and feasibility. RESULTS: At the 8-week follow-up, the intervention participants had significantly increased their total weekly MVPA by 135 minutes relative to the control group (P=.03), due primarily to increases in walking time (155 min/week increase relative to controls, P<.001). However, statistical differences between groups for total weekly MVPA and walking time were lost at the 20-week follow-up. There were no significant changes in vigorous physical activity, nor overall quality of life or mental health quality of life at either time point. High levels of engagement with the intervention, and particularly the self-monitoring features, were observed. CONCLUSIONS: An online, social networking physical activity intervention with pedometers can produce sizable short-term physical activity changes. Future work is needed to determine how to maintain behavior change in the longer term, how to reach at-need populations, and how to disseminate such interventions on a mass scale. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000488606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366239 (Archived by WebCite at http://www.webcitation.org/6ZVtu6TMz).

Engaging consumers in the Australian emergency mental health context: a qualitative perspective from clinicians working in the community.

Successfully engaging with consumers is seen as an essential component of mental healthcare, yet doing so can be challenging and little is understood about the unique engagement skills and attributes employed by mental health clinicians working in the emergency community context. Consequently, this qualitative study explored the engagement experiences of clinicians to identify the attributes used when engaging with consumers in this unique setting. We conducted two semi-structured focus groups in July and August 2011 with 16 clinicians employed at one metropolitan mental health organisation in South Australia. Using thematic analysis, we identified two key themes pertaining to the skills and attributes used for successful consumer engagement: (i) building trust, through communication style, an honest approach, facilitating choice and locating trust networks; and (ii) portraying genuine care, through showing respect, offering practical assistance and taking the least restrictive pathway. These findings highlight the unique nature of engagement in the emergency community mental health setting, as well as the flexibility and resourcefulness required to facilitate it.