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

Deadline for manuscript submissions: closed (20 November 2022) | Viewed by 55837

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Special Issue Editors

Dr. Jo Robinson

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Guest Editor

1. Orygen, Parkville, VIC 3052, Australia
2. Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
Interests: suicide prevention in young people; online interventions and social media; clinical interventions and health service systems; policy development and evaluation

Dr. Nicole Hill

E-Mail Website
Assistant Guest Editor

Telethon Kids Institute, Nedlands WA 6009, Australia
Interests: youth suicide prevention; detection, response and prevention of suicide and self-harm clusters; social transmission of suicidal behaviour

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on innovation in suicide prevention in the International Journal of Environmental Research and Public Health. 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://0-www-mdpi-com.brum.beds.ac.uk/journal/ijerph.

Suicide is one of the leading causes of preventable death worldwide and the leading cause of death in some sectors of the population. Suicide attempt and suicidal ideation are more common than suicide. Although many countries have developed suicide prevention strategies, rates of suicide, suicide attempt, and suicidal ideation are increasing in many parts of the world. This suggests that new approaches to suicide prevention are needed.

This Special Issue will have a focus on innovative approaches to the prevention of suicide, suicide attempt, and suicidal ideation. Submissions that focus on novel interventions, innovative methodologies, and program or policy evaluation are particularly encouraged. All study designs are welcome, including quantitative and qualitative studies, mixed methods, and systematic reviews and meta-analyses. Some keywords are listed below which may help guide submissions.

Dr. Jo Robinson
Dr. Nicole Hill
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 submissions that pass pre-check are 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 monthly 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 2500 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 prevention
interventions to prevent suicide, suicide attempt, and/or suicidal ideation
treatment interventions
health service reform
innovative methodological approaches
program or policy evaluation
novel interventions for vulnerable groups

Published Papers (12 papers)

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Research

15 pages, 5149 KiB

Open AccessArticle

Establishing Self-Harm Registers: The Role of Process Mapping to Improve Quality of Surveillance Data Globally

by Emily Bebbington, Rob Poole, Sudeep Pradeep Kumar, Anne Krayer, Murali Krishna, Peter Taylor, Keith Hawton, Rajesh Raman, Mohan Kakola, Madhu Srinivasarangan and Catherine Robinson

Int. J. Environ. Res. Public Health 2023, 20(3), 2647; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20032647 - 01 Feb 2023

Cited by 1 | Viewed by 1682

Abstract

Self-harm registers (SHRs) are an essential means of monitoring rates of self-harm and evaluating preventative interventions, but few SHRs exist in countries with the highest burden of suicides and self-harm. Current international guidance on establishing SHRs recommends data collection from emergency departments, but this does not adequately consider differences in the provision of emergency care globally. We aim to demonstrate that process mapping can be used prior to the implementation of an SHR to understand differing hospital systems. This information can be used to determine the method by which patients meeting the SHR inclusion criteria can be most reliably identified, and how to mitigate hospital processes that may introduce selection bias into these data. We illustrate this by sharing in detail the experiences from a government hospital and non-profit hospital in south India. We followed a five-phase process mapping approach developed for healthcare settings during 2019–2020. Emergency care provided in the government hospital was accessed through casualty department triage. The non-profit hospital had an emergency department. Both hospitals had open access outpatient departments. SHR inclusion criteria overlapped with conditions requiring Indian medicolegal registration. Medicolegal registers are the most likely single point to record patients meeting the SHR inclusion criteria from multiple emergency care areas in India (e.g., emergency department/casualty, outpatients, other hospital areas), but should be cross-checked against registers of presentations to the emergency department/casualty to capture less-sick patients and misclassified cases. Process mapping is an easily reproducible method that can be used prior to the implementation of an SHR to understand differing hospital systems. This information is pivotal to choosing which hospital record systems should be used for identifying patients and to proactively reduce bias in SHR data. The method is equally applicable in low-, middle- and high-income countries. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

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14 pages, 1473 KiB

Open AccessArticle

Social Media Sentiments on Suicides at the New York City Landmark, Vessel: A Twitter Study

by Paul Yip, Yunyu Xiao, Yucan Xu, Evangeline Chan, Florence Cheung, Christian S. Chan and Jane Pirkis

Int. J. Environ. Res. Public Health 2022, 19(18), 11694; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191811694 - 16 Sep 2022

Cited by 1 | Viewed by 2173

Abstract

Vessel is a landmark created by Heatherwick Studio where visitors can enjoy views of New York City from different heights and perspectives. However, between February 2020 and July 2021, four individuals jumped to their deaths from the landmark. Effective preventive solutions have yet to be identified, and the site is currently closed. In this study, we examined the trajectory of public sentiment on the suicide-related activity at Vessel on Twitter by investigating the engagement patterns and identifying themes about the four suicides from February 2020 to August 2021 (n = 3058 tweets). The results show increased levels of discussion about each successive suicide case in the first 14 days following each incident (from 6 daily tweets for the first case to 104 for the fourth case). It also took longer for relevant discussions to dissipate (4 days for the first and 14 days for the fourth case, KS statistic = 0.71, p < 0.001). Thematic analysis shows a shift from expressions of emotion to urging suicide prevention actions in the third and fourth cases; additionally, we detected growing support for restricting means. We suggest that, prior to the reopening of Vessel, collective efforts should be made to install safety protections and reduce further suicide risks. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

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11 pages, 1954 KiB

Open AccessArticle

Suicide and Attempted Suicide in Poland before and during the COVID-19 Pandemic between 2019 and 2021

by Jacek Stańdo, Adam Czabański, Żywilla Fechner, Ewa Baum, Karl Andriessen and Karolina Krysińska

Int. J. Environ. Res. Public Health 2022, 19(15), 8968; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19158968 - 23 Jul 2022

Cited by 5 | Viewed by 1969

Abstract

The COVID-19 pandemic is related to changes in rates of suicide and suicide attempts in many countries, and some differences have been observed regarding the prevalence of suicidal behaviours in different age and gender groups. The aim of this study is to analyse the number of suicides and suicide attempts per 100,000 people between 2019 and 2021 in Poland. Using police and government data on suicide and suicide attempts in Poland, three age categories were investigated: 13–24 years old, 25–65 years old, and above 65 years old, and the analysis encompassed the whole population and the populations of men and women separately. Study results indicated an increase in suicide attempts in the two younger age categories (aged 7–24 years and 25–65 years) between 2021 and 2019–2020. There was an increase in suicide among women in all age categories during the study period, whilst no increase was observed in suicide in men in any age group. The differences in the prevalence of suicide and attempted suicide in Poland during the COVID-19 pandemic in different age and gender groups indicate the need for tailored suicide prevention activities. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

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9 pages, 298 KiB

Open AccessArticle

Association of Updating Identification Documents with Suicidal Ideation and Attempts among Transgender and Nonbinary Youth

by Jonah P. DeChants, Myeshia N. Price, Amy E. Green, Carrie K. Davis and Casey J. Pick

Int. J. Environ. Res. Public Health 2022, 19(9), 5016; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19095016 - 20 Apr 2022

Cited by 4 | Viewed by 4171

Abstract

This study examines the association of access to concordant identity documents with attempting suicide in the last year among transgender and nonbinary youth. Data came from 6581 transgender and nonbinary youth who completed an online survey of lesbian, gay, bisexual, transgender, or queer (LGBTQ) youth ages 13–24 residing in the United States. Multivariate logistic regression was used to determine the adjusted odds of attempting suicide in the past year based on whether or not youth were able to change their identification documents. Both wanting to update one’s documents but not being able to (aOR = 2.04, CI = 1.412–2.95; p < 0.001) and being able to update one’s documents but not having done so (aOR = 1.74, CI = 1.22–2.50; p < 0.001) were associated with greater odds of attempting suicide in the last year, compared to youth who had changed their documents. Revising the way gender is captured on legal documents may be an efficacious public health intervention to reduce suicide risk among transgender and nonbinary youth. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

12 pages, 322 KiB

Open AccessArticle

Responding to Suicide Clusters in the Community: What Do Existing Suicide Cluster Response Frameworks Recommend and How Are They Implemented?

by Nicole T. M. Hill and Jo Robinson

Int. J. Environ. Res. Public Health 2022, 19(8), 4444; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084444 - 07 Apr 2022

Cited by 6 | Viewed by 2101

Abstract

Suicide clusters involve an excessive number of suicides, suicide attempts, or both, that occur close in space or time or involve social links between cluster members. Although suicide clusters are rare, evidence documenting the implementation of suicide cluster response activities in communities is required yet remains limited. In this study, we identified the core components of existing suicide cluster response frameworks through a search of the grey literature and conducted an international survey to assess the implementation of the core components by stakeholders with experience responding to a suicide cluster. The following six core components were identified from five cluster response frameworks and were incorporated into a survey assessing stakeholders’ experiences of responding to a suicide cluster: (1) Preparing for a suicide cluster; (2) Routine monitoring of suicide, suicide attempts, and cluster detection; (3) Coordination with the media and monitoring social media; (4) Identifying and supporting individuals at risk; (5) Promoting help-seeking and building community resilience; and (6) Long-term follow-up and evaluation. Twenty-six stakeholders completed the online survey. Many of the core components were implemented by stakeholders. However, gaps in practice were reported in terms of cluster surveillance, monitoring of referral uptake among bereaved individuals, and long-term evaluation. Barriers to implementation included the perceived availability and suitability of mental health services, and availability of long-term funding. Strategic policy and planning that addresses the practice-based experiences of communities has the potential to facilitate a more coordinated and timely response to suicide clusters. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

17 pages, 2117 KiB

Open AccessArticle

Understanding Aboriginal Models of Selfhood: The National Empowerment Project’s Cultural, Social, and Emotional Wellbeing Program in Western Australia

by Pat Dudgeon, Kate L. Derry, Carolyn Mascall and Angela Ryder

Int. J. Environ. Res. Public Health 2022, 19(7), 4078; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19074078 - 29 Mar 2022

Cited by 6 | Viewed by 13586

Abstract

Culturally safe and responsive interventions that acknowledge Aboriginal models of selfhood are needed. Such interventions empower Aboriginal peoples and communities by increasing self-determination over individual and community social and emotional wellbeing (SEWB). In response to this need, the National Empowerment Project developed the Cultural, Social, and Emotional Wellbeing Program (CSEWB). The CSEWB aims to strengthen SEWB and cultural identity and subsequently reduce psychological distress in Aboriginal peoples. An Aboriginal Participatory Action Research approach ensured community ownership and engagement. Seven research questions and a culturally modified adaption of the Most Significant Change technique informed a thematic analysis of the evaluation content. Aboriginal adults (n = 49; 53% ≥50 years, 66% female, 34% male) from three Western Australian urban communities participated in the program evaluation workshops. Participants reported the benefits of enhanced SEWB and reduced psychological distress. This research reaffirms the need for culturally safe programs that acknowledge social determinants of health and are guided by the SEWB framework. Long-term commitment from the government is needed to support such programs. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

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12 pages, 2409 KiB

Open AccessArticle

The Tool for Evaluating Media Portrayals of Suicide (TEMPOS): Development and Application of a Novel Rating Scale to Reduce Suicide Contagion

by Chloe Chang Sorensen, Mego Lien, Vicki Harrison, John J. Donoghue, Jeevanjot Singh Kapur, Song Hi Kim, Nhi Thi Tran, Shashank V. Joshi and Sita G. Patel

Int. J. Environ. Res. Public Health 2022, 19(5), 2994; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052994 - 04 Mar 2022

Cited by 1 | Viewed by 4964

Abstract

Research suggests that media adherence to suicide reporting recommendations in the aftermath of a highly publicized suicide event can help reduce the risk of imitative behavior, yet there exists no standardized tool for assessing adherence to these standards. The Tool for Evaluating Media Portrayals of Suicide (TEMPOS) allows media professionals, researchers, and suicide prevention experts to assess adherence to the recommendations with a user-friendly, standardized rating scale. An interdisciplinary team of raters constructed operational definitions for three levels of adherence to each of the reporting recommendations and piloted the scale on a sample of articles to assess reliability and clarify scale definitions. TEMPOS was then used to evaluate 220 news articles published during a high-risk period following the suicide deaths of two public figures. Post-hoc analyses of the results demonstrated how data produced by TEMPOS can be used to inform research and public health efforts, and inter-rater reliability analyses revealed substantial agreement across raters and criteria. A novel, wide-reaching, and practical approach to suicide prevention, TEMPOS allows researchers, suicide prevention professionals, and media professionals to study how adherence varies across contexts and can be used to guide future efforts to decrease the risk of media-induced suicide contagion. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

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15 pages, 4183 KiB

Open AccessArticle

Sound Decision Making in Uncertain Times: Can Systems Modelling Be Useful for Informing Policy and Planning for Suicide Prevention?

by Jo-An Occhipinti, Danya Rose, Adam Skinner, Daniel Rock, Yun Ju C. Song, Ante Prodan, Sebastian Rosenberg, Louise Freebairn, Catherine Vacher and Ian B. Hickie

Int. J. Environ. Res. Public Health 2022, 19(3), 1468; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031468 - 27 Jan 2022

Cited by 7 | Viewed by 3631

Abstract

The COVID-19 pandemic demonstrated the significant value of systems modelling in supporting proactive and effective public health decision making despite the complexities and uncertainties that characterise an evolving crisis. The same approach is possible in the field of mental health. However, a commonly levelled (but misguided) criticism prevents systems modelling from being more routinely adopted, namely, that the presence of uncertainty around key model input parameters renders a model useless. This study explored whether radically different simulated trajectories of suicide would result in different advice to decision makers regarding the optimal strategy to mitigate the impacts of the pandemic on mental health. Using an existing system dynamics model developed in August 2020 for a regional catchment of Western Australia, four scenarios were simulated to model the possible effect of the COVID-19 pandemic on levels of psychological distress. The scenarios produced a range of projected impacts on suicide deaths, ranging from a relatively small to a dramatic increase. Discordance in the sets of best-performing intervention scenarios across the divergent COVID-mental health trajectories was assessed by comparing differences in projected numbers of suicides between the baseline scenario and each of 286 possible intervention scenarios calculated for two time horizons; 2026 and 2041. The best performing intervention combinations over the period 2021–2041 (i.e., post-suicide attempt assertive aftercare, community support programs to increase community connectedness, and technology enabled care coordination) were highly consistent across all four COVID-19 mental health trajectories, reducing suicide deaths by between 23.9–24.6% against the baseline. However, the ranking of best performing intervention combinations does alter depending on the time horizon under consideration due to non-linear intervention impacts. These findings suggest that systems models can retain value in informing robust decision making despite uncertainty in the trajectories of population mental health outcomes. It is recommended that the time horizon under consideration be sufficiently long to capture the full effects of interventions, and efforts should be made to achieve more timely tracking and access to key population mental health indicators to inform model refinements over time and reduce uncertainty in mental health policy and planning decisions. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

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14 pages, 353 KiB

Open AccessArticle

They Told Me “This Isn’t a Hotel”: Young People’s Experiences and Perceptions of Care When Presenting to the Emergency Department with Suicide-Related Behaviour

by Jacinta Freeman, Penelope Strauss, Sharynne Hamilton, Charlotte Pugh, Katherine Browne, Suzanne Caren, Chris Harris, Lyn Millett, Warwick Smith and Ashleigh Lin

Int. J. Environ. Res. Public Health 2022, 19(3), 1377; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031377 - 26 Jan 2022

Cited by 5 | Viewed by 2468

Abstract

In Australia, the number of young people presenting to the emergency department with mental health concerns, in particular, suicidal behaviour (defined here as suicidal ideation, thoughts, intent and attempts) is increasing. Little is known about the experiences of Australian young people who present to hospital emergency departments with suicidal behaviour. In this qualitative study, we conducted a series of focus groups with 55 young people aged 16–25 years, with a view to developing a framework for youth suicide prevention for Western Australia. The data were analysed using a general inductive analysis approach. We explored the experiences and perceptions of the care and management of 35 young people presenting to Western Australian hospital emergency departments. Participants described a range of negative experiences relating to the emergency department environment, staff attitudes and their treatment by staff. We argue that adapting ED practices and approaches to young people presenting with suicidal thoughts and behaviours based on these findings will result in lower rates of repeated presentations and admissions to hospital and lower rates of suicide attempts and deaths by suicide. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

15 pages, 372 KiB

Open AccessArticle

The Mental Health and Social Media Use of Young Australians during the COVID-19 Pandemic

by Eleanor Bailey, Alexandra Boland, Imogen Bell, Jennifer Nicholas, Louise La Sala and Jo Robinson

Int. J. Environ. Res. Public Health 2022, 19(3), 1077; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031077 - 19 Jan 2022

Cited by 27 | Viewed by 10196

Abstract

Young people may be particularly vulnerable to the mental health impacts of the COVID-19 pandemic and may also be more likely to use social media at this time. This study aimed to explore young people’s mental health and social media use during the COVID-19 pandemic and examined their use of social media to seek and provide support for suicidal thoughts and self-harm during this period. Young people aged 16–25 (n = 371, M = 21.1) from the general population in Australia completed an anonymous, cross-sectional online survey advertised on social media from June to October 2020. Participants reported high levels of psychological distress, with over 40% reporting severe levels of anxiety and depression, and those with a mental health diagnosis were more likely to perceive the pandemic to have had a negative impact on their mental health. Gender-diverse participants appeared the most negatively impacted. Social media use was high, with 96% reporting use at least once a day, and two-thirds reporting an increase in social media use since the start of the pandemic. One-third had used social media to seek support for suicidal thoughts or self-harm, and half had used it to support another person. This study adds to a growing literature suggesting social media can provide an opportunity to support young people experiencing psychological distress and suicide risk. Uniquely, this study points to the utility of using social media for this purpose during high-risk periods such as pandemics, where access to face-to-face support may be limited. To promote the quality and safety of support provided on social media, resources for help-seekers and help-givers should be developed and disseminated. Social media companies must consider the vulnerability of some users during pandemics and do what they can to promote wellbeing and safety. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

15 pages, 751 KiB

Open AccessArticle

A Pilot Case-Control Study of the Social Media Activity Following Cluster and Non-Cluster Suicides in Australia

by Phillip Cheuk Fung Law, Lay San Too, Nicole T. M. Hill, Jo Robinson, Madelyn Gould, Jo-An Occhipinti, Matthew J. Spittal, Katrina Witt, Mark Sinyor, Benedikt Till, Nathaniel Osgood, Ante Prodan, Rifat Zahan and Jane Pirkis

Int. J. Environ. Res. Public Health 2022, 19(1), 343; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19010343 - 29 Dec 2021

Viewed by 2266

Abstract

Social media may play a role in the “contagion” mechanism thought to underpin suicide clusters. Our pilot case-control study presented a novel methodological approach to examining whether Facebook activity following cluster and non-cluster suicides differed. We used a scan statistic to identify suicide cluster cases occurring in spatiotemporal clusters and matched each case to 10 non-cluster control suicides. We identified the Facebook accounts of 3/48 cluster cases and 20/480 non-cluster controls and their respective friends-lists and retrieved 48 posthumous posts and replies (text segments) referring to the deceased for the former and 606 for the latter. We examined text segments for “putatively harmful” and “putatively protective” content (e.g., discussion of the suicide method vs. messages discouraging suicidal acts). We also used concept mapping, word-emotion association, and sentiment analysis and gauged user reactions to posts using the reactions-to-posts ratio. We found no “putatively harmful” or “putatively protective” content following any suicides. However, “family” and “son” concepts were more common for cluster cases and “xx”, “sorry” and “loss” concepts were more common for non-cluster controls, and there were twice as many surprise- and disgust-associated words for cluster cases. Posts pertaining to non-cluster controls were four times as receptive as those about cluster cases. We hope that the approach we have presented may help to guide future research to explain suicide clusters and social-media contagion. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

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10 pages, 3210 KiB

Open AccessArticle

The Opportunities and Challenges of the First Three Years of Open Up, an Online Text-Based Counselling Service for Youth and Young Adults

by Paul Siu Fai Yip, Wai-Leung Chan, Christian S. Chan, Lihong He, Yucan Xu, Evangeline Chan, Yui Chi Chau, Qijin Cheng, Siu-Hung Cheng, Florence Cheung, James Chow, Shirley Chow, Jerry Fung, Siu-Man Hsu, Yik Wa Law, Billie Lo, Sze-Man Miu, Wai Man Ng, Ken Ngai, Christy Tsang, Cynthia Xiong and Zhongzhi Xu Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(24), 13194; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182413194 - 14 Dec 2021

Cited by 9 | Viewed by 3595

Abstract

We present the opportunities and challenges of Open Up, a free, 24/7 online text-based counselling service to support youth in Hong Kong. The number of youths served more than doubled within the first three years since its inception in 2018 in response to increasing youth suicidality and mental health needs. Good practice models are being developed in order to sustain and further scale up the service. We discuss the structure of the operation, usage pattern and its effectiveness, the use of AI to improve users experience, and the role of volunteer in the operation. We also present the challenges in further enhancing the operation, calling for more research, especially on the identification of the optimal number of users that can be concurrently served by a counsellor, the effective approach to respond to a small percentage of repeated users who has taken up a disproportional volume of service, and the way to optimize the use of big data analytics and AI technology to enhance the service. These advancements will benefit not only Open Up but also similar services across the globe. Full article

(This article belongs to the Special Issue Novel Approaches to Suicide Prevention)

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