Crisis-The Journal of Crisis Intervention and Suicide Prevention最新文献

Background: Little is known about the underreporting of suicide deaths to the police in India. Aim: To document the extent and reasons of underreporting suicide deaths to the police by socio-demography of the deceased in India. Methods: Interviews documented if a suicide death was reported to the police for suicide deaths that occurred between 2019 and 2022 in India, identified as part of a national all-cause mortality survey in nine states. Further interviews in three of these states explored the reasons for underreporting of suicide deaths to the police. Results: The prevalence of underreporting suicide deaths to the police in India was 35.5% (95% CI 30.8, -40.6), 34.1% (95% CI 28.5, -40.2), and 38.6% (95% CI 30.1, -47.9) for both sexes combined, male, and female suicide deaths, respectively. The underreporting was significantly higher in 15-19 years (46.7%; 95% CI 32.7, -61.2) and in 50+ years (42.5%; 95% CI 32.1, -53.6) compared to those in 30-39 years (19.0%; 95% CI 10.8, -31.1). Avoidance of postmortem was the most cited reason for underreporting followed by compromise between the affected parties, with variations in reasons seen by sex of the deceased and state. Concerns related to social stigma, maintaining family reputation, and securing custody of young children were mentioned as reasons more for female than male suicide deaths. Limitations: Underreporting estimates rely on self-report subject to recall and social desirability bias. Reasons for nonreporting were collected postevent and may not reflect real-time family or community decision-making. Conclusion: One in three suicide deaths are not reported to the police in India, with variations in this underreporting by age, urbanicity, and state of the suicide deaths. These findings can allow for developing targeted awareness campaigns and community engagement in high underreporting areas rather than a one-size-fits-all approach, and simplifying the police protocols around postmortem can help to reduce this underreporting.

Background: Globally over 720,000 deaths yearly are due to suicide, approximately 20% due to pesticide self-poisoning. Poor school-connectedness has been shown to be associated with increased risk of suicidal thoughts and behaviors in high-income countries, while good school-connectedness is protective of suicidality. This study investigated associations between poor school-connectedness and self-poisoning in a low- and middle-income country. Methods: We used data collected in a hospital-based case-control study in rural Sri Lanka. Cases (n = 298) were adults admitted due to self-poisoning, and controls (n = 596) frequency matched on age and sex. Structured interviews assessed school-connectedness using four questions, and data on confounders (ethnicity, parental migration, child adversity, and parental education) were also collected. Associations were quantified using logistic regression. Results: Individuals with poorer relationships with other students (OR = 1.90, 95% CI 1.22, -2.95) and lower levels of school enjoyment (OR = 1.34, 95% CI 0.94, -1.92) were more likely to present for self-poisoning in adulthood. They were also more likely to report poor relationships with teachers, but this relationship was not as strong (OR = 1.30, 95% CI 0.90, -1.88). Limitations: The questionnaire used is not validated in this setting. Additionally, this is a retrospective study using a hospital sample, which may be impacted by recall bias and/or excluding individuals who did not seek hospital treatment. Conclusions: Interventions to improve school-connectedness in Sri Lanka, with a particular focus on relationships between students, may reduce self-poisoning in adulthood. Further research is needed to explore how to achieve this, and to understand the reasons for association between school-connectedness and self-poisoning.

Background: Suicide-related media reporting can influence suicidal thoughts and behaviors. Stories describing suicide methods can increase suicides (Werther effect), whereas those highlighting coping with suicidal crises can prevent them (Papageno effect). Aims: To assess the impact of media guidelines for suicide reporting on reporting quality and suicides. Method: Following PRISMA guidelines, we searched PubMed, Scopus, Embase, PsycInfo, and Web of Science up to February 10, 2025, with an update on November 17, 2025. We included ecological pre-post studies assessing changes in reporting quality and time-series analyses assessing changes in suicides after guideline release. Random-effects meta-analyses estimated pooled risk ratios (RRs) for reporting quality and incidence rate ratios (IRRs) for suicides. Results: Fifteen studies from 11 countries (2003-2025) were included (14 on reporting quality, three on suicides, two measuring both). Following guideline release, reporting quality improved for "Do educate the public about the facts of suicide and suicide prevention based on accurate information" (k = 13, RR = 1.56, 95% CI = 1.30, -1.88), "Don't describe the method used" (k = 12, RR = 1.33, 95% CI = 1.15, -1.53), and "Don't oversimplify the reason for a suicide or reduce it to a single factor" (k = 0, RR = 1.16, 95% CI = 1.02, -1.33). For other recommendations, pooled estimates generally favored the guidelines but were often imprecise, and in some cases, had substantial heterogeneity. We could not draw firm conclusions on their impact on suicides as only three studies assessed this outcome. Contour-enhanced funnel plots and Egger's tests suggested possible small-study effects for some recommendations. Limitations: All included studies included ecological before-and-after designs. Implementation strength was inconsistently reported, preventing analysis of its influence. Conclusions: Media guidelines appear to improve several aspects of reporting quality. Although evidence for impact on suicides is limited, guidelines are unlikely to cause any harm and may confer benefits through improved reporting standards. Further research is urgently needed to quantify their impact on suicides.

Background: Disclosure of a stigmatized experience such as suicidal thoughts and behaviors can have both positive and negative consequences. While online social media platforms have become an increasingly prevalent mode of disclosure for suicide attempt survivors, it remains unclear how suicide attempt survivors perceive online disclosures. Aims: We sought to explore the advantages and disadvantages of suicide-related disclosure via social media, from the perspective of suicide attempt survivors. Method: As part of a larger study, we analyzed responses from qualitative interviews with suicide attempt survivors (n = 18) and coded responses around advantages and disadvantages of disclosing via social media. Results: Advantages of social media disclosure discussed by participants were: anonymity, easy connection to support, and opportunity to support others. Disadvantages of disclosure via social media included: potential for triggering others, negative responses (e.g., trolling, cyberbullying), communication barriers, and the perception of attention-seeking. Limitations: The sample was a relatively small convenience sample who were open enough about their experiences with suicide to participate in research interviews. Conclusion: Quantitative methods are warranted to determine the relative salience of advantages and disadvantages. Future investigations might delve into the decision-making process of suicide-related disclosure via social media and develop guidance for making disclosure decisions.

Background/Aims: This study examines how normative beliefs (human rights-based and rationality-based) about suicide aligned with their support for compulsory psychiatric treatment. Method: A national telephone survey of 1,087 Taiwanese participants was conducted to assess opinions on suicide rights, suicide rationality, and psychiatric intervention. Multinominal logistic regression analyzed the relationship between beliefs about suicide and attitudes toward compulsory intervention. Results: Between 68.9% and 83.7% of the sample supported involuntary treatments, with 37.6% acknowledging the right to suicide and 24.7% considering suicide rational. Belief in this right did not correlate with support for compulsory treatment. However, those viewing suicide as rational were less likely to support compulsory psychiatric referral for those with, or without, mental illness (adjusted odds ratio [aOR] = 0.39, 95% confidence interval [CI] 0.27-0.57, p ≤.001; aOR = 0.29, 95% CI 0.16-0.53, p ≤.001) and compulsory psychiatric admission (aOR = 0.36, 95% CI 0.25-0.54, p ≤.001). Limitation: The cross-sectional design limits causal inferences. Relevant factors such as economic status, mental health stigma, and family suicide history were not measured. Conclusion: Compulsory psychiatric treatment was widely supported in Taiwan. Belief in the right to suicide had little impact, but individuals who viewed suicide as rational were more likely to oppose the intervention. This highlights the need to address cultural narratives for mental health policymaking.

Background: Military service is a significant stressor for posttraumatic stress disorder (PTSD) and suicidal ideation (SI). The study aimed to examine direct and indirect associations between unit social support, sense of coherence (SOC), PTSD, and SI. Method: This cross-sectional study included 140 Israeli soldiers (M_age 20.41 [SD = 1.19]). Data were extracted from self-report questionnaires. Mediation analyses were used to evaluate direct and indirect associations between unit social support (DRRI-2), SOC (SOC-13), PTSD (PCL-5), and SIS (Beck Suicide Ideation Scale). Results: Correlational analyses revealed that unit social support and SOC were positively related to each other, while both were negatively associated with PTSD symptoms and SI. A positive relationship existed between PTSD symptoms and SI, confirming their connection. Path analyses revealed two main patterns: first, unit social support was negatively associated with SI, but this relationship worked via two pathways, one through its negative relationship with PTSD symptoms and one through its positive relationship with SOC. Second, SOC was negatively associated with SI, primarily by reducing PTSD symptoms. Limitations: This is a cross-sectional study with no experimental manipulation; causal inferences are limited. Conclusion: SOC is negatively related to PTSD and SI, a finding in-line with longitudinal studies, which reveal SOC's buffering effect on these two outcomes. This highlights the importance of interventions aimed at enhancing soldiers' SOC, which could contribute to mitigating suicidality.

Background: Empathy plays a crucial role in motivating community engagement in suicide prevention. However, its relationship with helping behavior is not linear and can be influenced by moderating variables. Objective: This study examined the moderating role of self-efficacy and suicide-related knowledge (factual and perceived) in the relationship between empathy and the willingness to help. Method: Participants (N = 1,096) were recruited via social media and completed an online survey assessing sociodemographic data, empathy, willingness to help individuals at risk of suicide, intervention self-efficacy, and suicide-related knowledge (factual and perceived). Results: The moderation analyses showed that perceived knowledge is the main moderator of the relationship between empathy and willingness to help people at risk of suicide, with this association strengthening as perceived knowledge increases. Limitations: The cross-sectional design and use of convenience sampling restrict causal inference and reduce the generalizability of the findings. Conclusion: Multiple factors that shape the relationship between empathy and willingness to help in at-risk situations should be considered when developing intervention programs that promote empathy as a suicide prevention strategy.

Background: Signage designed to encourage help-seeking is a suicide prevention intervention used at public sites where suicides occur. Aims: We aimed to investigate the perspectives of people with lived experience of suicide on signs that are designed to encourage help-seeking. Method: We conducted a qualitative study using semistructured interviews undertaken in Melbourne, Australia, during April 2021. We showed participants photos of existing Lifeline (Australia's largest national crisis support line) signage used at public sites that are known for suicide and asked for their feedback. We used a deductive coding approach, guided by the interview topics and study aims. Results: We interviewed 12 participants, and most had previously seen such signs and could recollect elements of these. Participants considered that empathetic and uncomplicated messaging was important and viewed Lifeline branding favorably. Signs that participants perceived as unhelpful were those that contain multiple or unclear messaging, or messaging considered patronizing. The use of the word crisis was also viewed unfavorably by some. Limitations: Study limitations include our small sample size and our broad definition of lived experience. Conclusion: Our results may be of use to organizations looking to create or update signs. Future signs should be codesigned with people with lived experience of suicide.

Background: Suicide is a growing public health concern in India, with Kerala being one of the states with the highest suicide rates. Responsible media reporting is a crucial population-level suicide prevention strategy. However, the quality of suicide reporting in newspapers remains a concern. Aim: To assess the quality of newspaper reports of suicide in Kerala, India, against the World Health Organization (WHO) media guidelines for reporting suicide. Method: Content analysis of suicide reports published by the 11 most widely circulated Malayalam daily newspapers in Kerala, between June and November 2023. Results: A total of 1,068 suicide news reports were analyzed. Harmful reporting practices, such as reporting the method used (90.9%), mentioning negative life events (36.8%), stating the method in headlines (46.7%), and using photographs of the deceased (69.9%), were common, while helpful practices, such as providing contact details of helplines (0.7%), were rare. Limitations: The study is limited to print newspaper reports and does not examine suicide reporting in other media formats. Additionally, it focuses only on Malayalam newspapers in Kerala. Conclusion: The study highlights a low level of adherence to WHO guidelines indicating the need for effective dissemination of the guidelines and training of media professionals.

Background: Although emotion dysregulation and adverse childhood experiences (ACEs) are key psychosocial risk factors for suicidal ideation and suicide attempts, it remains unclear which specific dimensions of these factors can distinguish the transition from ideation to attempts. Aims: To determine whether specific dimensions of emotion dysregulation and adverse childhood experiences differentiate young adults with histories of suicidal ideation from those with histories of suicide attempts. Method: A sample of 418 young adults (63% non-Latinx White; 71% female; M = 23.56, SD = 2.85) completed measures of ACEs, emotion dysregulation, and suicidal ideation and attempts. Multinomial logistic regression assessed how specific dimensions of emotion dysregulation and ACEs predicted membership in three groups: no history of ideation or attempts, ideation only, and attempt history, controlling for depressive symptoms, age, and gender. Results: The suicidal ideation group reported greater cumulative ACEs and depressive symptoms than those without ideation/attempt history. The suicide attempts group reported greater ACEs and difficulties with goal-directed behavior than the other two groups. Difficulties engaging in goal-directed behavior and emotional awareness were more predictive of membership in the suicide attempts than the suicidal ideation group. Limitations: The cross-sectional, retrospective design, and predominantly White female sample limit causal inferences and generalizability. Conclusion: Focusing on specific emotion regulation strategies may improve outcomes for young adults at risk for suicidal ideation and attempts and with a history of ACEs. Goal-directed behavior and emotional awareness offer promising targets for intervention to reduce suicide risk in this population.