Operationalizing the Consolidated Framework for Implementation Research to build and support the lived experience workforce in direct health service provision.

BACKGROUND: The involvement of people with lived experience (LEX) workers in the development, design, and delivery of integrated health services seeks to improve service user engagement and health outcomes and reduce healthcare gaps. Yet, LEX workers report feeling undervalued and having limited influence on service delivery. There is a need for systematic improvements in how LEX workforces are engaged and supported to ensure the LEX workforce can fully contribute to integrated systems of care. OBJECTIVE: This study aimed to operationalize the Consolidated Framework for Implementation Research (CFIR) using a rigorous scoping review methodology and co-creation process, so it could be used by health services seeking to build and strengthen their LEX workforce. SEARCH STRATEGY: A systematic literature search of four databases was undertaken to identify peer-reviewed studies published between 2016 and 2022 providing evidence of the inclusion of LEX workers in direct health service provision. DATA EXTRACTION AND SYNTHESIS: A descriptive-analytical method was used to map current evidence of LEX workers onto the CFIR. Then, co-creation sessions with LEX workers (n = 4) and their counterparts-nonpeer workers (n = 2)-further clarified the structural policies and strategies that allow people with LEX to actively participate in the provision and enhancement of integrated health service delivery. MAIN RESULTS: Essential components underpinning the successful integration of LEX roles included: the capacity to engage in a co-creation process with individuals with LEX before the implementation of the role or intervention; and enhanced representation of LEX across organizational structures. DISCUSSION AND CONCLUSION: The adapted CFIR for LEX workers (CFIR-LEX) that was developed as a result of this work clarifies contextual components that support the successful integration of LEX roles into the development, design, and delivery of integrated health services. Further work must be done to operationalize the framework in a local context and to better understand the ongoing application of the framework in a health setting. PATIENT OR PUBLIC CONTRIBUTION: People with LEX were involved in the operationalization of the CFIR, including contributing their expertise to the domain adaptations that were relevant to the LEX workforce.

The impact of relationship type and closeness on mental health following suicide loss.

BACKGROUND: Most research investigating the effect of suicide on loss survivors has been limited to first-degree family members. Few studies examine the impact of suicide on others outside the immediate family and the influence of relationship type and closeness on mental health. METHODS: This study used data from a sample obtained through random digit dialing (n = 805) to assess exposure to suicide loss, relationship types, perceived closeness, and mental health symptoms (prolonged grief, depression, anxiety, and posttraumatic stress disorder). RESULTS: Familial status, friend status, and higher perceived closeness were associated with prolonged grief, depression, and posttraumatic stress disorder, with the strongest adjusted associations observed for posttraumatic stress disorder and prolonged grief. In general, the magnitude of adjusted standardized associations for closeness and mental health symptoms was stronger than those observed for familial status and mental health symptoms and friend status and mental health symptoms. CONCLUSION: Closeness, familial status, and friend status are associated with mental health symptoms experienced after suicide loss, but the magnitude of associations was strongest for closeness. Future studies should examine perceived closeness in addition to other factors related to relationship type and dynamics to assess the complexities of suicide bereavement reactions.

Impacts of exposure to suicide of a military colleague from the lived experience of veterans: Informing postvention responses from a military cultural perspective.

Although exposure to the suicide death of a military colleague has been shown quantitatively to increase suicide risk factors among veterans, there are very few studies where veterans have been asked about this experience. This article presents a qualitative analysis of 38 interviews with U.S. veterans with exposure to the suicide death of a military colleague in past war operations. Participants described the impact of exposure in relation to the military context and official response to the death, which had long-term ramifications. Our findings suggest suicide prevention and postvention responses for veterans should be informed by the lived experience of veterans, including those for whom this experience occurred significantly in the past, as the impacts of different military policies and practices in response to suicide deaths over time are relevant to the impact of exposure to death of a military colleague in the short and long term.

School-based multidisciplinary student-led clinics in health and Australian accreditation standards: A scoping review.

INTRODUCTION: Student-led clinics can provide health services to marginalised groups where service offerings are sparse or difficult to access, such as rural areas. Offering these services to children and young people can promote health and well-being by addressing the individual challenges and the social determinants of health. There is uncertainty, however, as to whether student-led clinics can meet Australian accreditation standards for health professionals completing degree programs. OBJECTIVE: This study aims to determine the capacity for health student placements in school-based student-led clinics to meet accreditation standards. DESIGN: A systematic scoping review was conducted based on Arksey and O'Malley's framework and the PRISMA-ScR statement. SETTING: Several databases were examined, including Ebsco (Academic Source and CINAHL), ProQuest (PsycINFO, ERIC) and grey literature sources along with a desktop review of accreditation standards across seven health disciplines. Two independent reviewers screened eligible studies. FINDINGS: The search retrieved 1037 records with 65 full-text papers assessed for eligibility. Eleven papers met the inclusion criteria. Based on the evidence, both nursing and exercise and sports science accreditation standards were best suited to student-led clinics. DISCUSSION: Although broad categories of work-integrated learning activities were applied, it appears feasible to expect accreditation standards for health disciplines at an Australian university to be a good fit for health student-led school-based clinics. CONCLUSION: Increasing health student placement opportunities within student-led clinics can improve the health and well-being of children and young people in regional, rural and remote (RRR) areas of Australia who may otherwise have limited access to allied health services.

Prevalence and risk factors of physical and psychological health among readymade garment workers in Bangladesh.

Objective. Poor health outcomes of Bangladeshi readymade garment (RMG) workers tend to be associated with a variety of occupational factors. This study aimed to investigate the prevalence of, and risk factors associated with, the physical and psychological health outcomes of Bangladeshi RMG workers. Methods. Responses to a cross-sectional survey from a convenience sample of 411 adult Bangladeshi RMG workers (mean age = 26.24 years; SD 6.40 years; female = 80%) were analysed using bivariate and multivariate (logistic regression models) analyses. Results. More than half of the participants reported headaches (61.6%) and colds/flu (51.3%), followed by fever (37.2%), diarrhoea (32.8%), bodily pain (29.9%) and respiratory infections (20.9%). For psychological health, stress (69.1%), anxiety (66.2%) and boredom (64.5%) were most prevalent, followed by sleeplessness (51.3%), depression (48.2%) and fear (34.3%). RMG workers from the factories located in Chattogram (a peripheral region compared to Dhaka) reported poorer physical and psychological health outcomes than those working in factories in Dhaka (the capital city of Bangladesh). Overall, compared to males, female RMG workers were more likely to be vulnerable to both physical and psychological health outcomes. Conclusion. Improvement in workplace conditions and safety programmes is needed to safeguard the overall health outcomes of Bangladeshi RMG workers.

Examining the Association Between Moral Injury and Suicidal Behavior in Military Populations: A Systematic Review.

The increasing number of suicides among military populations cannot be fully accounted for by conventional risk factors like Post-Traumatic Stress Disorder (PTSD). As a result, researchers and theorists propose that delving into the concept of Moral Injury could offer a more comprehensive understanding of the phenomenon of suicide. Moral Injury is not currently a recognized mental health disorder but can be associated with PTSD. Moral Injury is a multi-dimensional issue that profoundly affects emotional, psychological, behavioral, social, and spiritual well-being. The objective of this systematic review is to examine the association between Moral Injury and suicidal behavior (suicide ideation, plans and or suicide attempt) within military populations. The review will specifically concentrate on identifying and analyzing studies that have investigated the connection between these variables, with a specific focus on the context of military personnel both serving and former serving members. Of the 2214 articles identified as part of this review, 12 studies satisfied the research criteria with a total participant sample having an average age of 40.7 years. The male population accounted for 78.6% of the overall sample. Two studies were identified as high-quality, while the remaining ten were rated as moderate. The analysis of these twelve studies consistently affirms a connection between Moral Injury and suicidal behavior; most obviously, that exposure to morally injurious events substantially amplify the risk of suicide, with higher levels of potential exposure being linked to increased Moral Injury and heightened levels of suicidal behavior. Our review uncovered noteworthy findings regarding the association between Moral Injury and suicidal behavior, marking a pioneering effort in exploring this association and offering valuable insights into this emerging issue. Several limitations are noted regarding this review and recommendations are made concerning the need to prioritize, expand and employ longitudinal research designs that include non-military populations such as first responders (e.g., police, paramedics, firefighters) and medical, nursing, or allied health professionals-all disciplines known to be impacted by Moral Injury.

Unpacking the Meaning of Closeness, Reconsidering the Concept of Impact in Suicide Exposure, and Expanding Beyond Bereavement: "Just, I Hope You Don't Forget About Us".

Suicide exposure research has relied on samples of treatment-seeking kin, resulting in an attachment-based model centering bereavement as the most significant form of impact and obscuring other forms of significant and life-altering impact. From a community-based sample (N = 3010) exposed to suicide, we examine a subset (n = 104) with perceived high impact from the death yet low reported closeness to the person who died and analyze qualitative comments (n = 50). On average and out of 5.00, participants rated closeness as 1.56 but impact of death as 4.51. We illustrate dimensions of low closeness and identify themes on the meaning of impact: impact through society and systemic circumstances, impact through history and repeated exposure, impact through other people, impact as a motivator for reflection or change, and impact through shared resonance. Participants reported impact of death as significant or devastating, yet none of their comments reflected experiences typical of bereavement.

Qualitative research in suicidology: a systematic review of the literature of low-and middle-income countries.

BACKGROUND: Suicide is more prevalent among disadvantaged, discriminated, and marginalised people with the majority of global suicide deaths occurring in the low-and middle-income countries (LMICs). This can be attributed to sociocultural contexts and exacerbated by access to limited resources and services that can assist with early identification, treatment, and support. Accurate information on the personal experiences of suicide is lacking, as many LMICs legislate that suicide is illegal. METHODS: This study aims to review the qualitative literature to explore the experiences of suicide in LMICs from the first-person perspective. Following the PRISMA-2020 guidelines, the search for qualitative literature published between January 2010 and December 2021 was undertaken. A total number of 110 qualitative articles from 2569 primary studies met the inclusion criteria. Included records were appraised, extracted, and synthesised. RESULTS: The results provide lived experience insight into suicide from those living in LMICs, including understanding variations of the causes of suicides, the impacts on others exposed to suicide, existing support systems, and prevention measures to reduce suicide among LMICs. The study offers a contemporaryunderstanding of how people in LMIC experience suicide. CONCLUSIONS: The findings and recommendations are derived from the similarities and differences within the existing knowledge base that is dominated by evidence from high-income countries. Timely suggestions for future researchers, stakeholders, and policymakers are provided.

Predictors of Caregiver Burden Among Carers of Suicide Attempt Survivors.

Background: Family members often provide informal care following a suicide attempt. Carers may be vulnerable to caregiver burden. Yet, little is known about what contributes to this. Aims: To determine the predictors of caregiver burden in those carers who support people who have attempted suicide. Method: An online survey of 435 participants assessed exposure to suicide, caring behaviors, and psychological variables and caregiver burden. Results: A multivariate model explained 52% of variance in caregiver burden. Being female, closeness to the person, impact of suicide attempt, frequency of contact pre-attempt, and psychological distress were positively associated with caregiver burden. Confidence in supporting the person after suicide attempt, perceived adequacy of healthcare the person received and the support the carer received, and suicidal ideation of the carer were negatively associated with caregiver burden. Moderation analysis suggested that carers with high levels of distress reported negative association between suicidal ideation and caregiver burden. Limitations: The cross-sectional online survey design of self-identified carers is a limitation of the study. Conclusion: Carers are highly distressed, and if unsupported report increased suicide ideation. In their caring roles they may have contact with support services, thus attending to their needs may ameliorate caregiver burden and associated negative outcomes.

Key issues, challenges, and preferred supports for those bereaved by suicide: Insights from postvention experts.

For many, suicide bereavement is challenging. Postvention responses are few and evidence to inform them is lacking. Eighteen postvention experts completed an online survey regarding the key issues, challenges, and supports available to people bereaved by suicide. Participants were asked to identify the issues, then rank them in terms of importance at key times during the first 2 years after death, with navigating grief, managing relationships, and dealing with practical challenges identified. Access to information, practical assistance and non-judgmental support were most important early in the bereavement period. These findings provide a foundation for recommendations for postvention interventions.

Understanding solastalgia from a decolonised, Indigenist lens: a scoping review.

The objective of this review is to use a decolonised, Indigenist lens to understand the definition of solastalgia from an Aboriginal perspective, as a potential emotional response experienced by Aboriginal communities impacted by increasingly frequent natural disasters, such as bushfires. Initial search results revealed a lack of literature referencing solastalgia in an Aboriginal-specific context. Indigenist research methodologies such as Heuristic inquiry and Aboriginal Participatory Action Research (APAR) contributed to the identification of alternative terminologies, which led to the majority of the included publications referring to solastalgia-related concepts, with one included publication mentioning solastalgia specifically. These methods were consequently used to synthesize data, confirm results and contribute to final discussions. Lastly, our results determined that at this stage there is insufficient evidence to conclusively suggest that Aboriginal Peoples in a general sense, experience solastalgia. Acknowledging the ethical dilemma and potential harm of generalising personal philosophies and experiences based on Culture. Thereby, signify the need for further research in this space and in particular, from a decolonised, Indigenist perspective. Preface: In the context of this review, we as co-authors are mindful of and respect the tensions or politics associated with proclaiming or discussing the identities of Australia's First Peoples. Therefore, in the context of this review, the often preferred term Aboriginal refers to the traditional owners of Australia. Where possible, traditional place/tribe names are written to acknowledge the ownership and origins of the information referenced within this review. Furthermore, we wish to acknowledge the storeys and traditional knowledge shared by the authors of the studies referenced within this review. These words of Country and Kin have contributed to the development and conceptualisation of this literature review, and we wish to pay our respects and appreciation.

Co-creation of new knowledge: Good fortune or good management?

BACKGROUND: Potential solutions to bridging the research practice gap include collaborative frameworks and models. Yet there is little evidence demonstrating their application in practice. In addressing this knowledge gap, this in-depth case study explored how the co-creation of new knowledge framework and its four collaborative processes (co-ideation, co-design, co-implementation, and co-evaluation) are utilised to support people who had attempted suicide through an Australian psychoeducational program known as Eclipse. METHODS: Using a case study design and a thematic analysis methodology, multiple sources of qualitative data (collaborative group discussion, personal communications) were analysed inductively and deductively to examine the implementation of co-creation and explore the perspectives of researchers and stakeholders about co-creation and collaborative relationships. RESULTS: Three broad themes were identified: (1) understanding the language and practice of co-creation, (2) perception of trust formation, and (3) the value of co-creation opportunities. Ultimately, implementing co-creation with or between researchers, industry and people with lived experience requires trust, reciprocity, good fortune, and good management. While implementing co-creation, the co-creation framework was revised to include additional elements identified as missing from the initially proposed framework. CONCLUSION: Co-creation of new knowledge poses many challenges to researchers and stakeholders, particularly regarding its "messiness" and non-linear approach to implementation and evaluation. However, as this case study demonstrates, it has the potential to become an alternative framework of best practice for public health interventions in third sector organisations, most notably as it eliminates the often-lengthy gap reported between research evidence and translation into practice. The research highlights the need for co-creation to further study its effectiveness in integrating research and service delivery to generate new knowledge. This may lead to a cultural and behavioural change in the service provider's approach to research, offering better outcomes for providers, clients, policymakers, universities, and funders.

Organisations and researchers need to collaborate to produce new knowledge of health interventions. The literature identifies that there is a substantial evidence gap between producing knowledge and improving health outcomes. Here we reflect, via a case study methodology, on ways to co-create new knowledge by following a four-step collaborative process. The case study reviews the evaluation of an Australian-based psychoeducational program for people who attempt suicide by analysing multiple qualitative data sources to explore the perspectives of researchers and stakeholders. We discovered the need for a shared language of co-creation that focuses on experiences of collaboration while seeking out new value-creation opportunities and dismantling barriers. We learnt that implementing co-creation requires trust and good fortune within collaborative relationships alongside good management. Using the alternative collaboration framework of best practice for public health interventions in third sector organisations may eliminate gaps between research evidence and translation into practice, assisting health providers, clients, policymakers, universities, and funders.

Evidence of co-creation practices in suicide prevention in government policy: a directed and summative content analysis.

BACKGROUND: In Australia, the collaborative involvement of stakeholders, especially those with lived experience in mental health and suicide prevention, has become important to government policy and practice at Federal and State levels. However, little is known about how governments translate this intention into frameworks of co-creation for policy, funding programs, service improvement, and research and evaluation. We investigated the extent to which publicly available government policies refer to collaborative practice using an established translation model. METHODS: An exploratory directed and summative content analysis approach was used to analyse the contents of Federal (also known as Commonwealth), State and Territories policy documents on mental health and suicide prevention published in Australia between 2010 and 2021. The data was extracted, compared to an existing translation model, and summated to demonstrate the evidence of co-creation-related concepts between government and stakeholders. RESULTS: 40 policy documents (nine at the Federal and 31 at the State and Territory level) were identified and included in the analysis. Only 63% of policy documents contained references to the concept of co-design. Six of the State policies contained references to the concept of co-production. Across all policy documents, there were no references to other concepts in the model adopted for this study, such as co-creation, co-ideation, co-implementation, and co-evaluation. CONCLUSION: Although the government at Federal, State and Territory levels appear to support collaborative practice through partnership and co-design, this study suggests a narrow approach to the theoretical model for co-creation at a policy level. Implications for both research and practice are discussed.

The Paradoxical Impacts of the Minimum Wage Implementation on Ready-made Garment (RMG) Workers: A Qualitative Study.

There is no regular mandated increase in minimum wages for workers employed in the Bangladesh ready-made garment (RMG) industry. Workers in the past have relied on optional bonuses added to their monthly incomes to supplement their wages. However, a new minimum wage implemented in January 2019 in the Bangladesh RMG sector increased wages for many workers who are known to work under poor and exploitative working conditions. Qualitative in-depth interviews were conducted with fifteen currently employed RMG workers (female: 13, male: 2), which led to data saturation. The participants were purposively recruited from both export processing zone (EPZ) and non-EPZ factories located in Dhaka and Chattogram, the two largest cities of Bangladesh where the majority of RMG factories are situated. Transcribed interviews were analysed thematically. The findings revealed that working hours, production targets, work pressure, and workplace abuse have an impact on workers' health and well-being. In line with the Marxist notion of the "accumulation of capital", we argue that due to the profit maximization mindset of RMG owners and international brands, workers have not received the potential benefit of the newly implemented minimum wage as their conditions have been changed in other ways to offset the increase in salary. The article contributes to understanding how factory owners' profit maximization mindset dispossessed workers from receiving the real benefits of the newly implemented minimum wage and forced them to continue working within exploitative working environments. The study shows that the impact of minimum wages on poverty reduction is unlikely and outline the need for RMG labour market reform.

Understanding Emergency Department Healthcare Professionals' Perspectives of Caring for Individuals in Suicidal Crisis: A Qualitative Study.

Help seekers regularly present to Emergency Departments (EDs) when in suicidal crisis for intervention to ensure their immediate safety, which may assist in reducing future attempts. The emergency health workforce have unique insights that can inform suicide prevention efforts during this critical junction in an individual's experience with suicide. This paper explores the treatment and care delivery experiences of 54 health professionals working in EDs within one of the LifeSpan suicide prevention trial sites in Australia. Data was collected via six focus groups and six interviews. Thematic analysis resulted in three themes: (1) physicality of the emergency department, (2) juggling it all-the bureaucracy, practicalities, and human approach to care, and (3) impact of care delivery on ED staff. Findings highlight the need for workplace training that incorporates responding to the uncertainty of suicidal crisis, to compliment the solution-focused medical model of care. Broader policy changes to the ED system are also considered to ensure better outcomes for health professionals and help-seekers alike.

Effectiveness of Brief Contact Interventions for Bereavement: A Systematic Review.

Brief contact interventions are an efficient and cost-effective way of providing support to individuals. Whether they are an effective bereavement intervention is not clear. This systematic review included articles from 2014 to 2021.711 studies were identified, with 15 meeting inclusion criteria. The brief contact interventions included informational and emotional supports. Narrative synthesis identified that participants valued brief contact interventions, however some did not find them helpful. Exposure to a brief contact intervention was typically associated with improvements in wellbeing. Studies with comparison groups typically found significant but modest improvements in grief, depression symptoms and wellbeing associated with the intervention. However, one intervention was associated with significant deterioration of depression symptoms. Existing brief contact interventions for bereavement appear feasible, generally acceptable to the target population and are associated with improvements in wellbeing. Further development and evaluation to account for why improvements occur, and to identify any unintended impacts, is required.

Suicide exposure experience screener for use in therapeutic settings: A validation report.

INTRODUCTION: A brief screener assessing experience of exposure to suicide for use in therapeutic settings is warranted. To examine the concurrent validity of such a screening tool, labeled as the Suicide Exposure Experience Screener (SEES), the associations of the two SEES items: (i) reported closeness with the person who died by suicide and (ii) perceived impact of suicide death with psychological distress are presented. METHODS: Five separate datasets comprising surveys from Australia, Canada, and the United States (Ncombined  = 7782) were used to provide evidence of concurrent validity of closeness and impact of suicide exposure. RESULTS: Overall, closeness and impact were significantly correlated with measures of global distress across five different datasets, showing small to medium effect sizes. Closeness and impact were also intercorrelated demonstrating a large effect size across all surveys. This report used cross-sectional data and comprised varied sample sizes across different datasets that influenced statistical significance of obtained effects and did not tease apart the roles of cumulative exposure of suicide and prolonged bereavement in experiencing global distress. CONCLUSION: The SEES has clinical utility in determining psychological distress in bereaved individuals and is recommended for use in therapeutic settings.

A Psychoeducational Support Group Intervention for People Who Have Attempted Suicide: An Open Trial with Promising Preliminary Findings.

Psychoeducational groups have been used to address many health needs. Yet, there are few such options available for people who have attempted suicide. This study presents preliminary findings from an open trial of Eclipse, an 8-week closed, psychoeducational group for people who have attempted suicide. It examined the effectiveness of the Eclipse program in reducing suicidal ideation, depressive symptoms, perceived burdensomeness and thwarted belongingness, and increasing resilience and help-seeking. Results showed statistically significant improvements in depressive symptoms, perceived burdensomeness, resilience and help-seeking from baseline (T1) to immediate post-test (T2), and in perceived burdensomeness from T1 to 1-month follow-up (T3). A pervasiveness analysis showed that over half of the participants reported improvements in key study outcomes, respectively, as a result of participating in the Eclipse group. Psychoeducational support groups could provide broad application for those who have previously attempted suicide in decreasing severity of suicidal thinking by reductions in depressive symptoms, burdensomeness, and thwarted belongingness.

A mixed-methods systematic review of suicide prevention interventions involving multisectoral collaborations.

BACKGROUND: Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement. METHODS: The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed. RESULTS: Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co-design or co-evaluation stage. CONCLUSION: This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the field of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed that the inclusion of co-researchers from communities or organizations is defined as co-creation, but further analysis revealed that collaboration was not consistent across the duration of projects. Researchers and practitioners should consider issues of power and equity in multisectoral collaborations and encourage increased engagement with TSOs, to rigorously research and evaluate suicide prevention services.