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Special Issue "Advances in Suicide Research"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (28 February 2018).

Special Issue Editors

Guest Editor
Dr. Kairi Kõlves

Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt Campus, Brisbane, QLD 4122, Australia
Website | E-Mail
Interests: epidemiology of suicidal behaviour; suicide and suicide prevention in children; suicide bereavement and postvention
Guest Editor
Prof. Dr. Merike Sisask

School of Governance Law and Society, Tallinn University, Estonian-Swedish Mental Health and Suicidology Institute, Õie 39, Tallinn 1161, Estonia
Website | E-Mail

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on the advances in suicide research in the International Journal of Environmental Research and Public Health (IJERPH) (ISSN 1660-4601, IF 2.101). The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph

Suicide research as a multidisciplinary field has established itself over the last century. In that time, diverse pathways, numerous risk and protective factors have been identified. Research in the field has given rise to a range of theories and has led to the realisation that suicidal behaviour is a complex phenomenon and its prevention is a challenge needing a culturally sensitive global response. Furthermore, different study designs have been encouraged to drive understanding of the mechanisms of suicidal behaviour, and prevention, in order to fill the existing gaps in knowledge.

In this Special Issue, we welcome papers that utilise quantitative, qualitative and mixed methods study designs and also innovative methodological and conceptual frameworks in advancing suicide research.

Dr. Kairi Kõlves
Prof. Dr. Merike Sisask
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Suicide
  • Suicidal behavior
  • Self-harm
  • Risk and protective factors
  • Pathways
  • Suicide prevention
  • Translational research

Published Papers (26 papers)

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Editorial

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Open AccessEditorial
Towards a Greater Understanding of Suicidal Behaviour and Its Prevention
Int. J. Environ. Res. Public Health 2018, 15(8), 1629; https://doi.org/10.3390/ijerph15081629
Received: 20 July 2018 / Revised: 22 July 2018 / Accepted: 31 July 2018 / Published: 1 August 2018
Cited by 1 | PDF Full-text (317 KB) | HTML Full-text | XML Full-text
Abstract
Suicidal behaviour continues to be an important topic of research and significant public health concern globally [...] Full article
(This article belongs to the Special Issue Advances in Suicide Research)

Research

Jump to: Editorial, Review, Other

Open AccessArticle
Health Professionals Facing Suicidal Patients: What Are Their Clinical Practices?
Int. J. Environ. Res. Public Health 2018, 15(6), 1210; https://doi.org/10.3390/ijerph15061210
Received: 10 April 2018 / Revised: 5 June 2018 / Accepted: 5 June 2018 / Published: 8 June 2018
Cited by 1 | PDF Full-text (352 KB) | HTML Full-text | XML Full-text
Abstract
Clinical work with suicidal people is a demanding area. Little is known about health professionals’ practices when faced with suicidal patients. The aims of this study were to: (1) describe the practices most likely to be adopted by professionals facing a suicidal patient [...] Read more.
Clinical work with suicidal people is a demanding area. Little is known about health professionals’ practices when faced with suicidal patients. The aims of this study were to: (1) describe the practices most likely to be adopted by professionals facing a suicidal patient and (2) analyze the differences according to professional characteristics (group, specific training on suicide, and experience with suicidal patients). A self-report questionnaire that was developed for this study was filled out by 239 participants. Participants were psychologists, psychiatrists, and general practitioners who work in different contexts: hospitals, public health centres, schools or colleges, and community centres. Principal components analysis, analyses of variance, and t-tests were used. Four components were identified: (1) Comprehensive risk assessment; (2) protocols, psychotherapy and connectedness; (3) multidisciplinary clinical approach; and, (4) family, explaining a total of variance of 44%. Positive associations between suicide-related variables (training and experience) and practices were found. In general, health professionals’ practices are evidence-based, however a relevant percentage of professionals can benefit from training and improve their practices. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students
Int. J. Environ. Res. Public Health 2018, 15(6), 1068; https://doi.org/10.3390/ijerph15061068
Received: 11 March 2018 / Revised: 28 April 2018 / Accepted: 19 May 2018 / Published: 24 May 2018
Cited by 1 | PDF Full-text (522 KB) | HTML Full-text | XML Full-text
Abstract
Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the “Saving and Empowering Young Lives in Europe” (SEYLE) project to [...] Read more.
Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the “Saving and Empowering Young Lives in Europe” (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE’s Hungarian randomly selected high school sample (N = 995) was completed with a randomly selected vocational school sample (N = 140) in Budapest, Hungary. Participants aged 14–17 years completed the SEYLE project’s self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ2(1) = 12.231, p< 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessArticle
Mood Regulation Focused CBT Based on Memory Reconsolidation, Reduced Suicidal Ideation and Depression in Youth in a Randomised Controlled Study
Int. J. Environ. Res. Public Health 2018, 15(5), 921; https://doi.org/10.3390/ijerph15050921
Received: 9 March 2018 / Revised: 25 April 2018 / Accepted: 30 April 2018 / Published: 5 May 2018
Cited by 2 | PDF Full-text (634 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Suicide attempts and suicidal ideation in adolescence are considered to be related to suicide and psychiatric adversity later in life. Secondary prevention by improving the treatment of suicidal youth is a distinct possibility. In this study, treatment with a systematised mood-regulation focused cognitive [...] Read more.
Suicide attempts and suicidal ideation in adolescence are considered to be related to suicide and psychiatric adversity later in life. Secondary prevention by improving the treatment of suicidal youth is a distinct possibility. In this study, treatment with a systematised mood-regulation focused cognitive behavioural therapy (MR-CBT) (n = 15) was compared with treatment as usual (TAU) (n = 12) in a group of depressed adolescents in a clinical setting. MR-CBT focuses on mood regulation by means of counter conditioning with memory reconsolidation being the proposed mechanism of change. Subjects practice keeping emotionally positive memories to diminish the emotional impact of negative memories. Symptoms of depression were tested with a short version of the Mood and Feelings Questionnaire (SMFQ), and wellbeing with the World Health Organization 5 Wellbeing Index (WHO-5). Suicidal events were rated according to the clinical interview Columbia Suicide Severity Rating Scale (C-SSRS). Suicidal events at the end of treatment were significantly reduced in the MR-CBT group, but not in the TAU group. Depression and wellbeing improved significantly in both treatment groups. While far from conclusive, the results are encouraging enough to suggest that further studies should be undertaken to examine whether psychotherapy focusing on mood regulation for young individuals at risk might enhance secondary prevention of suicide. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessArticle
Expressed Emotion, Shame, and Non-Suicidal Self-Injury
Int. J. Environ. Res. Public Health 2018, 15(5), 890; https://doi.org/10.3390/ijerph15050890
Received: 14 March 2018 / Revised: 15 April 2018 / Accepted: 26 April 2018 / Published: 30 April 2018
Cited by 2 | PDF Full-text (372 KB) | HTML Full-text | XML Full-text
Abstract
A cross-sectional study examining relationships between perceived family Expressed Emotion and shame, emotional involvement, depression, anxiety, stress and non-suicidal self-injury, in 264 community and online adults (21.6% male). We compared self-injurers with non-self-injurers, and current with past self-injurers. Self-injurers experienced more family Expressed [...] Read more.
A cross-sectional study examining relationships between perceived family Expressed Emotion and shame, emotional involvement, depression, anxiety, stress and non-suicidal self-injury, in 264 community and online adults (21.6% male). We compared self-injurers with non-self-injurers, and current with past self-injurers. Self-injurers experienced more family Expressed Emotion (EE) than non-injurers (t(254) = −3.24, p = 0.001), linear contrasts explaining 6% of between-groups variability (F(2, 254) = 7.36, p = 0.001, η2 = 0.06). Differences in EE between current and past self-injurers were not significant. Overall shame accounted for 33% of between-groups variance (F(2, 252) = 61.99, p < 0.001, η2 = 0.33), with linear contrasts indicating self-injurers experienced higher levels compared to non-injurers (t(252) = −8.23, p < 0.001). Current self-injurers reported higher overall shame than past self-injurers (t(252) = 6.78, p < 0.001). In further logistic regression, emotional involvement and overall shame were the only significant predictors of self-injury status. With every one-unit increase in emotional involvement, odds of currently engaging in self-injury decreased by a factor of 0.860. Conversely, a one-unit increase in overall shame was associated with an increase in the odds of being a current self-injurer by a factor of 1.05. The findings have important treatment implications for engaging key family members in intervention and prevention efforts. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Suicidal Ideation and Healthy Immigrant Effect in the Canadian Population: A Cross-Sectional Population Based Study
Int. J. Environ. Res. Public Health 2018, 15(5), 848; https://doi.org/10.3390/ijerph15050848
Received: 9 March 2018 / Revised: 22 April 2018 / Accepted: 23 April 2018 / Published: 25 April 2018
Cited by 2 | PDF Full-text (360 KB) | HTML Full-text | XML Full-text
Abstract
Understanding suicidal ideation is crucial for preventing suicide. Although “healthy immigrant effect” is a phenomenon that has been well documented across a multitude of epidemiological and social studies—where immigrants are, on average, healthier than the native-born, little research has examined the presence of [...] Read more.
Understanding suicidal ideation is crucial for preventing suicide. Although “healthy immigrant effect” is a phenomenon that has been well documented across a multitude of epidemiological and social studies—where immigrants are, on average, healthier than the native-born, little research has examined the presence of such effect on suicidal ideation. The objective of this study is to investigate if there is a differential effect of immigration identity on suicidal ideation and how the effect varies by socio-demographic characteristics in the Canadian population. Data from the Canadian Community Health Survey in year 2014 were used. Multivariate logistic regression was employed. Our findings indicated that recent immigrants (lived in Canada for 9 or less years) were significantly less likely to report suicidal ideation compared with non-immigrants. However, for established immigrants (10 years and above of living in Canada), the risk of suicidal ideation converged to Canadian-born population. Moreover, male immigrants were at significantly lower risk of having suicidal ideation than Canadian-born counterparts; whereas, female immigrants did not benefit from the “healthy immigrant effect”. Our findings suggest the need for targeted intervention strategies on suicidal ideation among established immigrants and female immigrants. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessArticle
The Impact of Caller Gender on Telephone Crisis-Helpline Workers’ Interpretation of Suicidality in Caller Vignettes
Int. J. Environ. Res. Public Health 2018, 15(4), 831; https://doi.org/10.3390/ijerph15040831
Received: 25 March 2018 / Revised: 13 April 2018 / Accepted: 18 April 2018 / Published: 23 April 2018
Cited by 2 | PDF Full-text (1165 KB) | HTML Full-text | XML Full-text
Abstract
Telephone crisis-line workers (TCWs) are trained in a variety of techniques and skills to facilitate the identification of suicidal callers. One factor that may influence the implementation of these skills is gender. This study used an experimental design to explore whether helpline callers [...] Read more.
Telephone crisis-line workers (TCWs) are trained in a variety of techniques and skills to facilitate the identification of suicidal callers. One factor that may influence the implementation of these skills is gender. This study used an experimental design to explore whether helpline callers being identified as male or female is associated with TCWs’ ratings of callers’ potential for suicide risk and TCWs’ intention to use support- or intervention-oriented skills with callers. Data were collected using an online self-report survey in an Australian sample of 133 TCWs. The results suggest that under some circumstances the callers’ gender might influence TCWs’ intention to use intervention-oriented skills with the caller. Implications for the training of telephone crisis workers, and those trained in suicide prevention more broadly are discussed. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessArticle
Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps
Int. J. Environ. Res. Public Health 2018, 15(4), 828; https://doi.org/10.3390/ijerph15040828
Received: 9 March 2018 / Revised: 17 April 2018 / Accepted: 17 April 2018 / Published: 23 April 2018
Cited by 2 | PDF Full-text (340 KB) | HTML Full-text | XML Full-text
Abstract
Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking [...] Read more.
Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Coronial Practice, Indigeneity and Suicide
Int. J. Environ. Res. Public Health 2018, 15(4), 765; https://doi.org/10.3390/ijerph15040765
Received: 7 March 2018 / Revised: 11 April 2018 / Accepted: 10 April 2018 / Published: 16 April 2018
Cited by 2 | PDF Full-text (300 KB) | HTML Full-text | XML Full-text
Abstract
All available data suggest that, like many other Indigenous peoples, Australian Aborigines are significantly more likely to kill themselves than are non-Aboriginal Australians. This statistical disparity is normally positioned an objective, ontological and undeniable social fact, a fact best explained as a function [...] Read more.
All available data suggest that, like many other Indigenous peoples, Australian Aborigines are significantly more likely to kill themselves than are non-Aboriginal Australians. This statistical disparity is normally positioned an objective, ontological and undeniable social fact, a fact best explained as a function of endemic community disadvantage and disenfranchisement. This research explores the possibility that higher-than-normal Aboriginal suicide rates may also be a function of coronial decision-making practices. Based upon in-depth interviews with 32 coroners from across Australia, the following conclusions emerged from the data. First, coroners have differing perceptions of Indigenous capacity, and are less likely to have concerns about intent when the suicide is committed by an Indigenous person. Second, coroners have identified divergent scripts of Indigenous suicide, particularly its spontaneity and public location, and this supports rather than challenges, a finding of suicide. Third, the coronial perception of Indigenous life is a factor which influences a suicide determination for Indigenous deaths. Finally, the low level of Indigenous engagement with the coronial system, and the unlikelihood of a challenge to the finding of suicide by Indigenous families, means that a coronial determination of suicide is more likely. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
The Cost of Youth Suicide in Australia
Int. J. Environ. Res. Public Health 2018, 15(4), 672; https://doi.org/10.3390/ijerph15040672
Received: 24 February 2018 / Revised: 29 March 2018 / Accepted: 3 April 2018 / Published: 4 April 2018
Cited by 4 | PDF Full-text (301 KB) | HTML Full-text | XML Full-text | Correction
Abstract
Suicide is the leading cause of death among Australians between 15 and 24 years of age. This study seeks to estimate the economic cost of youth suicide (15–24 years old) for Australia using 2014 as a reference year. The main outcome measure is [...] Read more.
Suicide is the leading cause of death among Australians between 15 and 24 years of age. This study seeks to estimate the economic cost of youth suicide (15–24 years old) for Australia using 2014 as a reference year. The main outcome measure is monetized burden of youth suicide. Costs, in 2014 AU$, are measured and valued as direct costs, such as coronial inquiry, police, ambulance, and funeral expenses; indirect costs, such as lost economic productivity; and intangible costs, such as bereavement. In 2014, 307 young Australians lost their lives to suicide (82 females and 225 males). The average age at time of death was 20.4 years, representing an average loss of 62 years of life and close to 46 years of productive capacity. The average cost per youth suicide is valued at $2,884,426, including $9721 in direct costs, $2,788,245 as the value of lost productivity, and $86,460 as the cost of bereavement. The total economic loss of youth suicide in Australia is estimated at $22 billion a year (equivalent to US$ 17 billion), ranging from $20 to $25 billion. These findings can assist decision-makers understand the magnitude of adverse outcomes associated with youth suicide and the potential benefits to be achieved by investing in effective suicide prevention strategies. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults
Int. J. Environ. Res. Public Health 2018, 15(4), 666; https://doi.org/10.3390/ijerph15040666
Received: 1 March 2018 / Revised: 29 March 2018 / Accepted: 29 March 2018 / Published: 3 April 2018
Cited by 6 | PDF Full-text (397 KB) | HTML Full-text | XML Full-text
Abstract
People bereaved by suicide are at increased risk of suicide, but evidence is lacking that available interventions reduce suicide risk. Few large-scale studies have described the views of suicide-bereaved people regarding their needs for support. Our objective was to explore the nature of [...] Read more.
People bereaved by suicide are at increased risk of suicide, but evidence is lacking that available interventions reduce suicide risk. Few large-scale studies have described the views of suicide-bereaved people regarding their needs for support. Our objective was to explore the nature of young adults’ experiences of support after bereavement by suicide and their views on valued and unhelpful aspects. We conducted a cross-sectional study of staff and students aged 18–40 at 37 United Kingdom (UK) higher educational institutions in 2010, eliciting qualitative responses to two questions probing experiences of support and unmet needs after the suicide of a close contact. We conducted thematic analysis of responses from 420 adults bereaved by suicide, of whom 75% had received support after the loss. We identified three broad descriptive areas corresponding to important aspects of support: value and experiences of the support received; views on specific support needs; and reasons for not seeking support. We found that needs for emotional support exist throughout the social networks of people who die by suicide but are often hidden. Our findings suggest a need for proactive offers of support from family, friends, and professionals after suicide, repeated regularly in case a bereaved person does not feel ready for support early on. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
The Impact of Suicide Bereavement on Educational and Occupational Functioning: A Qualitative Study of 460 Bereaved Adults
Int. J. Environ. Res. Public Health 2018, 15(4), 643; https://doi.org/10.3390/ijerph15040643
Received: 1 March 2018 / Revised: 28 March 2018 / Accepted: 29 March 2018 / Published: 31 March 2018
Cited by 6 | PDF Full-text (351 KB) | HTML Full-text | XML Full-text
Abstract
People bereaved by suicide are at an increased risk of suicide and of dropping out of education or work. Explanations for these associations are unclear, and more research is needed to understand how improving support in educational or work settings for people bereaved [...] Read more.
People bereaved by suicide are at an increased risk of suicide and of dropping out of education or work. Explanations for these associations are unclear, and more research is needed to understand how improving support in educational or work settings for people bereaved by suicide might contribute to reducing suicide risk. Our objective was to explore the impact of suicide on occupational functioning. We conducted a cross-sectional online study of bereaved adults aged 18–40, recruited from staff and students of British higher educational institutions in 2010. We used thematic analysis to analyse free text responses to two questions probing the impact of suicide bereavement on work and education. Our analysis of responses from 460 adults bereaved by suicide identified three main themes: (i) specific aspects of grief that impacted on work performance, cognitive and emotional domains, and social confidence; (ii) structural challenges in work or educational settings including a lack of institutional support, the impact of taking time off, and changes to caring roles; and (iii) new perspectives on the role of work, including determination to achieve. Institutional support should be tailored to take account of the difficulties and experiences described. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessFeature PaperArticle
The Function of Personality in Suicidal Ideation from the Perspective of the Interpersonal-Psychological Theory of Suicide
Int. J. Environ. Res. Public Health 2018, 15(4), 636; https://doi.org/10.3390/ijerph15040636
Received: 15 February 2018 / Revised: 27 March 2018 / Accepted: 29 March 2018 / Published: 30 March 2018
Cited by 1 | PDF Full-text (393 KB) | HTML Full-text | XML Full-text
Abstract
The Interpersonal-Psychological Theory of Suicide (IPTS) has been increasingly studied over the last years, responding to the demand for a valid framework addressing suicidality. Yet, only a few studies have explored the function of personality in the IPTS and none with clinical patients. [...] Read more.
The Interpersonal-Psychological Theory of Suicide (IPTS) has been increasingly studied over the last years, responding to the demand for a valid framework addressing suicidality. Yet, only a few studies have explored the function of personality in the IPTS and none with clinical patients. We aimed to contribute to fill this gap in investigating the relationship between personality as conceptualized by the Five-Factor Model, the IPTS constructs, and a dimensional measure of current suicidal ideation. We conducted correlation, multiple linear regression, and path analyses based on a trait-interpersonal framework in a sample of 201 individuals visiting the psychiatric emergency room of a general hospital with current suicidal ideation. Neuroticism (positively) and openness (negatively) predicted perceived burdensomeness, while neuroticism (positively) and extraversion (negatively) predicted thwarted belongingness. Higher conscientiousness and lower extraversion were both predictors of the acquired capability for suicide. However, none of the models involving path analyses with IPTS variables as mediators of the relationship between personality traits and suicidal ideation was adequately adjusted to the data. Thus, it appears that personality plays a significant albeit modest role in suicidality when considered from an IPTS perspective. As personality is frequently assessed in the clinical routine, health professionals should consider it as complementary to detect individuals at risk of or presenting suicidal ideation. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Parents’ Experiences of Suicide-Bereavement: A Qualitative Study at 6 and 12 Months after Loss
Int. J. Environ. Res. Public Health 2018, 15(4), 618; https://doi.org/10.3390/ijerph15040618
Received: 28 February 2018 / Revised: 22 March 2018 / Accepted: 24 March 2018 / Published: 28 March 2018
Cited by 4 | PDF Full-text (292 KB) | HTML Full-text | XML Full-text
Abstract
The death of a child by suicide is a severe trauma, placing parents at greater risk of psychological morbidity and physical health problems compared to other causes of death. However, few studies have examined the aftermath and bereavement experience for parents following the [...] Read more.
The death of a child by suicide is a severe trauma, placing parents at greater risk of psychological morbidity and physical health problems compared to other causes of death. However, few studies have examined the aftermath and bereavement experience for parents following the death of a child to suicide, limiting the ability to guide effective postvention services through empirical research. The current study, which was part of a larger longitudinal investigation of suicide bereavement in Queensland, Australia, examined the individual experiences of both mothers and fathers bereaved by suicide over time, specifically at the six month and 12 month time points after their loss. Bereaved parents who had provided written consent to be contacted for research purposes were identified through the Queensland Suicide Register, and took part in individual, semi-structured interviews. Generic qualitative analysis identified three key themes: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose. Some participants showed indications of meaning-making and post-traumatic growth at 12 months after the suicide. According to the dual process model of bereavement, it is likely that participants were still oscillating between sense-making and meaning making, indicating that adapting to bereavement is a dynamic and fluctuating process. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Association of Overcrowding and Turnover with Self-Harm in a Swiss Pre-Trial Prison
Int. J. Environ. Res. Public Health 2018, 15(4), 601; https://doi.org/10.3390/ijerph15040601
Received: 28 February 2018 / Revised: 22 March 2018 / Accepted: 22 March 2018 / Published: 27 March 2018
Cited by 3 | PDF Full-text (692 KB) | HTML Full-text | XML Full-text
Abstract
Self-harm is a common issue in detention and includes both suicidal and non-suicidal behaviours. Beyond well-known individual risk factors, institutional factors such as overcrowding (i.e., when the prison population exceeds its capacity) and turnover (i.e., the rate at which the prison population is [...] Read more.
Self-harm is a common issue in detention and includes both suicidal and non-suicidal behaviours. Beyond well-known individual risk factors, institutional factors such as overcrowding (i.e., when the prison population exceeds its capacity) and turnover (i.e., the rate at which the prison population is renewed), may also increase the risk of self-harm. However, these factors are understudied or previous studies reported inconsistent findings. This study investigated the association of self-harm with overcrowding and turnover in the largest pre-trial Swiss prison in Geneva. Data were collected yearly between 2011 and 2017. Measures included self-harm (all kinds of self-injuring acts requiring medical attention, including self-strangulations and self-hangings). We performed meta-regressions to analyse the relationships between self-harm and institutional factors. Self-harm events were frequent, with a prevalence estimate of 26.4%. Overcrowding and turnover were high (average occupation rate of 177% and average turnover of 73%, respectively). Overcrowding and turnover were significantly associated with self-harm (respectively b = 0.068, p < 0.001 and (b = 1.257, p < 0.001). In both cases, self-harm was higher when overcrowding and turnover increased. Overcrowding and turnover raise important human rights concerns and have damaging effects on the health of people living in detention. Identification of and care for this vulnerable population at risk of self-harm are needed and institutional factors should be addressed. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessArticle
Copycats in Pilot Aircraft-Assisted Suicides after the Germanwings Incident
Int. J. Environ. Res. Public Health 2018, 15(3), 491; https://doi.org/10.3390/ijerph15030491
Received: 18 January 2018 / Revised: 7 March 2018 / Accepted: 8 March 2018 / Published: 11 March 2018
Cited by 3 | PDF Full-text (301 KB) | HTML Full-text | XML Full-text
Abstract
Aircraft-assisted pilot suicide is a rare but serious phenomenon. The aim of this study was to evaluate changes in pilot aircraft-assisted suicide risks, i.e., a copycat effect, in the U.S. and Germany after the Germanwings 2015 incident in the French Alps. Aircraft-assisted pilot [...] Read more.
Aircraft-assisted pilot suicide is a rare but serious phenomenon. The aim of this study was to evaluate changes in pilot aircraft-assisted suicide risks, i.e., a copycat effect, in the U.S. and Germany after the Germanwings 2015 incident in the French Alps. Aircraft-assisted pilot suicides were searched in the U.S. National Transportation Safety Board (NTSB) accident investigation database and in the German Bundestelle für Flugunfalluntersuchung (BFU) Reports of Investigation database five years before and two years after the deliberate crash of the Germanwings flight into the French Alps in 2015. The relative risk (RR) of the aircraft-assisted pilot suicides was calculated. Two years after the incident, three out of 454 (0.66%) fatal incidents were aircraft-assisted suicides compared with six out of 1292 (0.46%) in the prior five years in the NTSB database. There were no aircraft-assisted pilot suicides in the German database during the two years after or five years prior to the Germanwings crash. The relative aircraft-assisted pilot suicide risk for the U.S. was 1.4 (95% CI 0.3–4.2) which was not statistically significant. Six of the pilots who died by suicide had told someone of their suicidal intentions. We consider changes in the rate to be within a normal variation. Responsible media coverage of aircraft incidents is important due to the large amount of publicity that these events attract. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Exposure to Suicide in High Schools: Impact on Serious Suicidal Ideation/Behavior, Depression, Maladaptive Coping Strategies, and Attitudes toward Help-Seeking
Int. J. Environ. Res. Public Health 2018, 15(3), 455; https://doi.org/10.3390/ijerph15030455
Received: 4 February 2018 / Revised: 22 February 2018 / Accepted: 28 February 2018 / Published: 6 March 2018
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Abstract
Adolescents’ exposure to a peer’s suicide has been found to be associated with, as well as to predict, suicidal ideation and behavior. Although postvention efforts tend to be school-based, little is known about the impact of a schoolmate’s suicide on the school’s student [...] Read more.
Adolescents’ exposure to a peer’s suicide has been found to be associated with, as well as to predict, suicidal ideation and behavior. Although postvention efforts tend to be school-based, little is known about the impact of a schoolmate’s suicide on the school’s student population overall. The present study seeks to determine whether there is excess psychological morbidity among students in a school where a schoolmate has died by suicide, and whether students’ attitudes about coping and help-seeking strategies are more or less problematic in such schools. Students in twelve high schools in Suffolk and Westchester counties in New York State—2865 students at six schools where a student had died by suicide within the past six months, and 2419 students at six schools where no suicide had occurred within the current students’ tenure—completed an assessment of their suicidal ideation and behavior, depressive symptoms, coping and help-seeking attitudes, stressful life events, and friendship with suicide decedent (if applicable). No excess morbidity (i.e., serious suicidal ideation/behavior and depression) was evident among the general student population after a schoolmate’s death by suicide; however, the risk of serious suicidal ideation/behavior was elevated among students at exposed schools who had concomitant negative life events. There was a significant relationship between friendship with the decedent and morbidity, in that students who were friends, but not close friends, of the decedents had the greatest odds of serious suicidal ideation/behavior. Overall, students in exposed schools had more adaptive attitudes toward help-seeking; but this was not true of the decedents’ friends or students with concomitant negative life events. The implications of the findings for postvention strategies are discussed. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessArticle
Suicidal Ideation among Youth Living in the Slums of Kampala, Uganda
Int. J. Environ. Res. Public Health 2018, 15(2), 298; https://doi.org/10.3390/ijerph15020298
Received: 16 January 2018 / Revised: 4 February 2018 / Accepted: 5 February 2018 / Published: 9 February 2018
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Abstract
The purpose of this study is to examine the factors associated with suicidal ideation among youth living in the slums of Kampala, Uganda. Analyses are based on cross-sectional survey data, collected in 2014, of a convenience sample (n = 1134) of urban [...] Read more.
The purpose of this study is to examine the factors associated with suicidal ideation among youth living in the slums of Kampala, Uganda. Analyses are based on cross-sectional survey data, collected in 2014, of a convenience sample (n = 1134) of urban service-seeking youth participating in a Uganda Youth Development Link drop-in center. Logistic regression analyses were computed to determine the psychosocial factors associated with suicidal ideation. Among youth participants, 23.54% (n = 266) reported suicidal ideation in the past year. In the multivariable analysis, suicidal ideation was associated with being female (OR: 1.61; 95% CI: 1.15, 2.25), reporting one (OR: 1.51; 95% CI: 1.05, 2.18) or two deceased parents (OR: 1.55; 95% CI: 1.03, 2.35), ever living on the streets (OR: 2.65; 95% CI: 1.86, 3.79), problem drinking (OR: 1.83; 95% CI: 1.19, 2.80), sexually transmitted infection (OR: 1.59; 95% CI: 1.14, 2.21), ever being raped (OR: 1.49; 95% CI: 1.01, 2.20), and experiencing physical child abuse (OR: 2.40; 95% CI: 1.75, 3.27). Our findings underscore many unmet needs in this vulnerable population. However, strategies that specifically seek to address problem drinking—a modifiable risk factor for suicidal ideation—may be particularly warranted in this low-resource setting. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Characteristics of Stress and Suicidal Ideation in the Disclosure of Sexual Orientation among Young French LGB Adults
Int. J. Environ. Res. Public Health 2018, 15(2), 290; https://doi.org/10.3390/ijerph15020290
Received: 16 January 2018 / Revised: 2 February 2018 / Accepted: 4 February 2018 / Published: 7 February 2018
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Abstract
Background: Lesbians, gays, and bisexual people (LGB) present high levels of suicidal ideation. The disclosure of sexual orientation is a stressful experience which presents a high suicide risk. Research has not paid sufficient attention to stress during this disclosure in order to understand [...] Read more.
Background: Lesbians, gays, and bisexual people (LGB) present high levels of suicidal ideation. The disclosure of sexual orientation is a stressful experience which presents a high suicide risk. Research has not paid sufficient attention to stress during this disclosure in order to understand suicide among LGB people. The aims of this study were to investigate: (1) the characteristics of stress during this revelation, more precisely cognitive appraisal, emotions, and coping; and (2) associations between these characteristics and suicidal ideation. Method: A total of 200 LGB young adults answered the “Stressful situation assessment questionnaire”, focusing on the most stressful disclosure of sexual orientation they have ever experienced. Results: Avoidance coping is a good predictor of suicidal ideation, and mediates the association between primary appraisal (risk “Harm myself and others”) and suicidal ideation. Conclusions: Our study illustrates the need to better understand stress during the disclosure of sexual orientation to prevent and care for suicide risk among LGB young adults. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessArticle
Patterns of Signs That Telephone Crisis Support Workers Associate with Suicide Risk in Telephone Crisis Line Callers
Int. J. Environ. Res. Public Health 2018, 15(2), 235; https://doi.org/10.3390/ijerph15020235
Received: 15 December 2017 / Revised: 11 January 2018 / Accepted: 22 January 2018 / Published: 30 January 2018
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Abstract
Signs of suicide are commonly used in suicide intervention training to assist the identification of those at imminent risk for suicide. Signs of suicide may be particularly important to telephone crisis-line workers (TCWs), who have little background information to identify the presence of [...] Read more.
Signs of suicide are commonly used in suicide intervention training to assist the identification of those at imminent risk for suicide. Signs of suicide may be particularly important to telephone crisis-line workers (TCWs), who have little background information to identify the presence of suicidality if the caller is unable or unwilling to express suicidal intent. Although signs of suicide are argued to be only meaningful as a pattern, there is a paucity of research that has examined whether TCWs use patterns of signs to decide whether a caller might be suicidal, and whether these are influenced by caller characteristics such as gender. The current study explored both possibilities. Data were collected using an online self-report survey in a Australian sample of 137 TCWs. Exploratory factor analysis uncovered three patterns of suicide signs that TCWs may use to identify if a caller might be at risk for suicide (mood, hopelessness, and anger), which were qualitatively different for male and female callers. These findings suggest that TCWs may recognise specific patterns of signs to identify suicide risk, which appear to be influenced to some extent by the callers’ inferred gender. Implications for the training of telephone crisis workers and others including mental-health and medical professionals, as well as and future research in suicide prevention are discussed. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessArticle
Self-Harm among Young People Detained in the Youth Justice System in Sri Lanka
Int. J. Environ. Res. Public Health 2018, 15(2), 209; https://doi.org/10.3390/ijerph15020209
Received: 12 December 2017 / Revised: 17 January 2018 / Accepted: 18 January 2018 / Published: 26 January 2018
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Abstract
Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age [...] Read more.
Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age 15.0 years, SD = 2.3) detained in the youth justice system in Sri Lanka. Structured face-to-face questionnaires assessed demographic characteristics, family and social background, substance use, self-harm history (including frequency, method, and intention), bullying victimization, physical and sexual abuse (victimization and perpetration), and exposure to self-harm/suicide by others. Seventy-seven participants (43%) reported a lifetime history of self-harm, 19 of whom (25%) who reported doing so with suicidal intent. Fifty participants (65% of those with a history of self-harm) reported engaging in self-harm impulsively, with no prior planning. A history of self-harm was associated with being female, prior sexual abuse victimization, prior exposure to self-harm by friends, and a lifetime history of self-harm ideation. High rates of substance use, bullying victimization, parental incarceration, and exposure to suicide were reported across the sample. Young people detained in the youth justice system in Sri Lanka are a vulnerable group with high rates of self-harm, substance use, and psychosocial risk factors. Strategies for identifying and preventing self-harm, and targeted psychological interventions designed specifically to address impulsivity, may contribute to more positive outcomes in this marginalised population. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Protective Factors in the Inuit Population of Nunavut: A Comparative Study of People Who Died by Suicide, People Who Attempted Suicide, and People Who Never Attempted Suicide
Int. J. Environ. Res. Public Health 2018, 15(1), 144; https://doi.org/10.3390/ijerph15010144
Received: 11 December 2017 / Revised: 6 January 2018 / Accepted: 8 January 2018 / Published: 16 January 2018
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Abstract
Epidemiological data shows an alarming prevalence of suicide in Aboriginal populations around the world. In Canada, the highest rates are found in Inuit communities. In this article, we present the findings of a secondary analysis conducted with data previously collected as part of [...] Read more.
Epidemiological data shows an alarming prevalence of suicide in Aboriginal populations around the world. In Canada, the highest rates are found in Inuit communities. In this article, we present the findings of a secondary analysis conducted with data previously collected as part of a larger study of psychological autopsies conducted in Nunavut, Canada. The objective of this secondary analysis was to identify protective factors in the Inuit population of Nunavut by comparing people who died by suicide, people from the general population who attempted suicide, and people from the general population who never attempted suicide. This case-control study included 90 participants, with 30 participants in each group who were paired by birth date, sex, and community. Content analysis was first conducted on the clinical vignettes from the initial study in order to codify the presence of protective variables. Then, inferential analyses were conducted to highlight differences between each group in regards to protection. Findings demonstrated that (a) people with no suicide attempt have more protective variables throughout their lifespan than people who died by suicide and those with suicide attempts within the environmental, social, and individual dimensions; (b) people with suicide attempts significantly differ from the two other groups in regards to the use of services; and (c) protective factors that stem from the environmental dimension show the greatest difference between the three groups, being significantly more present in the group with no suicide attempt. Considering these findings, interventions could focus on enhancing environmental stability in Inuit communities as a suicide prevention strategy. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
Open AccessArticle
Few Sex Differences in Hospitalized Suicide Attempters Aged 70 and Above
Int. J. Environ. Res. Public Health 2018, 15(1), 141; https://doi.org/10.3390/ijerph15010141
Received: 4 December 2017 / Revised: 10 January 2018 / Accepted: 11 January 2018 / Published: 16 January 2018
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Abstract
Relatively little research attention has been paid to sex issues in late life suicidal behaviour. The aim was to compare clinical characteristics of women and men aged 70+ who were hospitalized after a suicide attempt. We hypothesized higher depression and anxiety scores in [...] Read more.
Relatively little research attention has been paid to sex issues in late life suicidal behaviour. The aim was to compare clinical characteristics of women and men aged 70+ who were hospitalized after a suicide attempt. We hypothesized higher depression and anxiety scores in women, and we expected to find that men would more often attribute the attempt to health problems and compromised autonomy. Participants (56 women and 47 men, mean age 80) were interviewed by a psychologist. In addition to psychiatric and somatic health assessments, participants responded to an open-ended question concerning attributions of the attempt. There were no sex differences in depression and anxiety. Forty-five percent of the men and 14% of the women had a history of substance use disorder (p = 0.02). At least one serious physical disability was noted in 60.7% of the women and 53.2% of the men (p = 0.55). Proportions attributing their attempt to somatic illness did not differ (women, 14.5% vs. men 17.4%, p = 0.79), and similar proportions attributed the attempt to reduced autonomy (women, 21.8% vs. men, 26.1%, p = 0.64). We found strikingly similar figures for depression scores, functional disability and attributions for attempting suicide in older men and women. Larger studies are needed in diverse settings as sex differences might be influenced by cultural context. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Review

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Open AccessReview
Caring for Young People Who Self-Harm: A Review of Perspectives from Families and Young People
Int. J. Environ. Res. Public Health 2018, 15(5), 950; https://doi.org/10.3390/ijerph15050950
Received: 22 February 2018 / Revised: 24 April 2018 / Accepted: 3 May 2018 / Published: 10 May 2018
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Abstract
Self-harm among young people remains largely stigmatised and misunderstood. Parents have been identified as key facilitators in the help-seeking process, yet they typically report feeling ill-equipped to support the young person in their care. The aim of this review was to examine the [...] Read more.
Self-harm among young people remains largely stigmatised and misunderstood. Parents have been identified as key facilitators in the help-seeking process, yet they typically report feeling ill-equipped to support the young person in their care. The aim of this review was to examine the perspectives of both young people (aged 12–28) and parents and to develop the conceptual framework for a future qualitative study. A systematic search of MEDLINE and PsycINFO was performed to identify articles that focused on the experiences of family members and young people related to managing the discovery of self-harm. Fourteen articles were included for review. Four addressed the perspectives of young people and 10 reported on the impact of adolescent self-harm on parents. The impact of self-harm is substantial and there exists a discrepancy between the most common parental responses and the preferences of young people. In addition, parents are often reluctant to seek help for themselves due to feelings of shame and guilt. This highlights the need for accessible resources that seek to alleviate parents’ distress, influence the strategies implemented to manage the young person’s self-harm behaviour, reduce self-blame of family members, and increase the likelihood of parental help seeking. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Open AccessReview
Systematic Literature Review of Attempted Suicide and Offspring
Int. J. Environ. Res. Public Health 2018, 15(5), 937; https://doi.org/10.3390/ijerph15050937
Received: 28 February 2018 / Revised: 20 April 2018 / Accepted: 3 May 2018 / Published: 8 May 2018
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Abstract
Background: Exposure to parental suicide attempt is associated with higher risks of adverse outcomes like lower educational performance, drug abuse and delinquent behavior. When a patient is hospitalized after a suicide attempt, this presents a unique opportunity to identify whether the patient [...] Read more.
Background: Exposure to parental suicide attempt is associated with higher risks of adverse outcomes like lower educational performance, drug abuse and delinquent behavior. When a patient is hospitalized after a suicide attempt, this presents a unique opportunity to identify whether the patient has children, and thereby provide adequate follow-up for both the parent/patient and their children. The objective of this paper was to review the existing literature on follow-up measures for children subjected to parental suicide attempt. Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a systematic literature search. Results: The search resulted in a total of 1275 article titles, of which all abstracts were screened. Out of these, 72 full text papers were read, and a final four articles were included. Three of the included papers described parts of the same study from an emergency department in The Hague, where a protocol was implemented for monitoring and referring children of parents attempting suicide. The fourth article described the association between maternal attempted suicide and risk of abuse or neglect of their children. Conclusions: The lack of research in this particular area is striking. The circumstances surrounding a parent’s suicide attempt call for appropriate familial care. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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Other

Open AccessBrief Report
Research Priorities in Suicide Prevention: Review of Australian Research from 2010–2017 Highlights Continued Need for Intervention Research
Int. J. Environ. Res. Public Health 2018, 15(4), 807; https://doi.org/10.3390/ijerph15040807
Received: 28 February 2018 / Revised: 18 April 2018 / Accepted: 18 April 2018 / Published: 20 April 2018
Cited by 5 | PDF Full-text (389 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Suicide is a major public health concern in Australia and globally, requiring targeted research efforts to build the evidence base for its effective prevention. We examined current and future priorities in Australian suicide prevention research during the period 2010–2017, and compared these to [...] Read more.
Suicide is a major public health concern in Australia and globally, requiring targeted research efforts to build the evidence base for its effective prevention. We examined current and future priorities in Australian suicide prevention research during the period 2010–2017, and compared these to 1999–2006 baseline data. We classified current research priorities in terms of the type of research published in 424 journal articles and 36 grants and fellowships funded during 2010–2017. A questionnaire administered to 390 stakeholders identified future research priorities. The total number of suicide prevention focussed journal articles and the value of funded grants increased dramatically. Congruent with baseline data, current research priorities in 2010–2017 reflected a strong emphasis on epidemiological studies, while funding for intervention studies declined. This is despite the fact that stakeholders continually identified intervention studies as being the highest future research priority. If we are to make real advances in suicide prevention, we need to know what works, and identify and test effective interventions. This study highlighted the existing dearth and continued need for intervention research. Mechanisms to support future intervention research in suicide prevention are likely to lead to significant gains in knowledge and population health. Full article
(This article belongs to the Special Issue Advances in Suicide Research)
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