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

Background: This study examined if firefighters (an occupational group at elevated suicide risk) who have made a suicide plan involving a firearm reported higher suicidal intent than those whose plans did not involve a firearm. Methods: Participants included 173 firefighters (M [SD] age = 32.0 [9.9], 95.8% male) who reported having made a suicide plan during their tenure as firefighters. We used a self-report version of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) to determine the presence and nature of suicide plans during firefighter tenure. We used Item 4 of the Suicidal Behaviors Questionnaire-Revised (SBQ-R) to assess suicidal intent. Results: Overall, 44.5% of suicide plans involved firearms. Firefighters who reported a suicide plan involving a firearm reported significantly higher mean levels of suicidal intent than firefighters who did not report a suicide plan involving a firearm. Limitations: This investigation relied on a cross-sectional convenience sample which limits our ability to establish causal claims. Conclusions: Firefighters who report a suicide plan specifically using a firearm may represent an especially at-risk group. Clinicians should assess for both suicidal intent and means during risk assessments and deliver rigorous lethal means safety counseling to mitigate suicide risk among firefighters.

Suicide is a major public health concern globally, and despite decades of research, there has been a disappointing lack of progress in identifying effective prevention strategies and interventions. We argue over-reliance on traditional statistical significance cutoffs and underreporting of marginal findings may be limiting the clinical benefits of research in the field of suicide prevention and in turn impeding practical progress. The consistent reliance on statistically significant results at p < .05 may limit the visibility of potentially promising results to clinicians making treatment decisions. Expanding awareness of promising interventions - which can then be further scrutinized and subjected to further research - could have an important and needed impact on the field. The American Statistical Association has called upon researchers to view the p-value as continuous, with the call being adopted by leading journals. However, most suicide journals do not have explicit policies around how to use p-values for evaluating the strength of the evidence, and the use of continuous p-values has clearly not been routinely adopted by suicide researchers. We want to call upon suicide researchers to be more open to considering and publishing marginally significant findings that suggest promising trends for suicide prevention strategies and interventions.

Evaluations of interventions targeting the population level are an essential component of the policy development cycle. Pre-post designs are widespread in suicide prevention research but have several significant limitations. To inform future evaluations, our aim is to explore the three most frequently used approaches for assessing the association between population-level interventions or exposures and suicide - the pre-post design, the difference-in-difference design, and Poisson regression approaches. The pre-post design and the difference-in-difference design will only produce unbiased estimates of an association if there are no underlying time trends in the data and there is no additional confounding from other sources. Poisson regression approaches with covariates for time can control for underlying time trends as well as the effects of other confounding factors. Our recommendation is that the default position should be to model the effects of population-level interventions or exposures using regression methods that account for time effects. The other designs should be seen as fall-back positions when insufficient data are available to use methods that control for time effects.

Background: Suicide risk is elevated among first responders. The three-step theory of suicide (3ST), not yet tested in first responders, proposes that the combination of pain and hopelessness leads to suicidal desire, but most relevant studies examine psychological pain and a few studies exist regarding the impact of physical pain. Aims: This study aimed to replicate and expand the understanding of the 3ST by examining physical and psychological pain in Step 1 within first responders. Method: First responders (n = 204) completed an anonymous online survey assessing physical pain, psychological pain, hopelessness, and suicidal desire. Moderation analyses were used to test whether psychological pain and physical pain, respectively, potentiate the relationship between hopelessness and suicidal desire. Results: Physical pain moderated the relationship between hopelessness and suicidal desire, such that high levels of physical pain potentiated the relationship and low levels diminished the relationship, while psychological pain did not. Findings support the 3ST and provide evidence for the important role of physical pain in examining suicidal desire among first responders. Limitations and Conclusion: Although data were cross-sectional, results may inform development of measures tailored to first responders, which could ultimately lead to improved methods for assessing critical components of first responder and suicide risk.

Background: Exposure to suicide is associated with a range of psychosocial harms which Australian employers have a legislated responsibility to mitigate. Aims: Examine the impact of suicide on staff, current workplace responses and the efficacy of a new, systemic model of workplace postvention. Method: Interviews and focus groups with 54 staff in 22 workplaces from the commercial, government, and not-for-profit sectors. Results: Every participant had experienced the suicide of a client or colleague and reported a range of short- and long-term negative impacts, including suicidal ideation. This contrasted with the overall lack of workplace postvention, which increased the risks of psychosocial harms to staff. The new model was effective in tailoring a systemic approach to workplace postvention. Limitations: The small size of the sample limits generalizability; however, the prevalence of exposure to suicide and lack of workplace preparedness were strikingly consistent. Conclusion: The impact of suicide on staff is significant and current workplace responses are ineffective and potentially harmful. The new model improves staff and workplace preparedness through tailored and co-designed training, governance and supports.

Background: Crisis supporters can experience numerous stressors in their role that can impact their own mental well-being. The area remains underexplored in research, particularly relating to substance use, and new trends in the role such as working remotely or the impact of providing chat-based support. Aims: This study identifies crisis support-related stressors, as well as levels of mental well-being and substance use, and factors associated with mental well-being. Method: Participants (n = 422) were recruited from four leading crisis support services and via social media advertising. They responded to an online survey, assessing demographics, stressors, mental well-being (compassion fatigue, compassion satisfaction, and psychological distress), substance use, and coping styles. Results: Findings identified several important stressors (e.g., argumentative callers) and moderate to high rates of compassion fatigue and psychological distress. High levels of compassion satisfaction were reported, and levels of risky substance use were low. Problem-focused coping emerged as a key factor related to positive mental well-being, while emotion-focused, avoidant coping, remote work, and providing chat-based support were linked to negative well-being. Limitations: The study's cross-sectional design and convenience sample limit causal inferences and generalizability. Conclusion: The findings reveal significant stressors and challenges in crisis supporters that require consideration and intervention.

Background: Men account for 75% of all suicide deaths in Australia. Societally dominant masculine norms have been theorized to be linked with suicidality and reduced help-seeking. However, evidence is needed to establish this relationship further. Aims: To further understand the relationships between 11 masculine norms, suicidal ideation, and mental health help-seeking behavior longitudinally in Australian males. Method: We analyzed data from a cohort of 8,214 males (aged 18-55 years), using logistic regression to examine if conformity to any of the 11 masculine norms measured by the Conformity to Masculine Norms Inventory (CMNI-22) at Wave 1 was associated with suicidal ideation and help-seeking at Wave 2. Results: Analyses revealed that being in the high conformity group for the norm of emotional control at Wave 1 was associated with higher odds of suicidal ideation longitudinally. Being in the low conformity group for the global construct of masculine norms and the specific norms of emotional control and power over women was associated with higher rates of mental health help-seeking behavior longitudinally. Limitations: The CMNI-22 scale's limited construct validity and the use of a single-item measure for suicidal ideation may have restricted the accurate capture of masculine norms and suicidal behaviors in Australian men. Conclusion: These results provide support for the contention that suicidality is a profoundly gendered phenomenon by showing an association between masculine norms and suicidal ideation in men. These norms should be a point of focus of male suicide prevention initiatives.

Background: The literature is scant on the associations between employment-related variables and suicidal ideation. Aims: The objectives were to explore these associations in the national French working population. Methods: The study relied on two independent national French surveys and their samples of 22,420 workers (employees and self-employed workers) and 25,628 employees, respectively. Employment variables included occupation, economic activity of the company, public/private sector, company size, permanent/temporary work, full/part time, seniority, and employee/self-employed worker. Suicidal ideation was assessed using one item. The associations between employment variables and suicidal ideation were studied using bi- and multivariable weighted analyses (Rao-Scott Chi-2 test and logistic regression). Gender differences were explored and covariates were taken into account. Results: The associations between employment variables and suicidal ideation were mostly not statistically significant. Some differences in suicidal ideation between occupations and economic activities were difficult to interpret due to overlaps in the confidence intervals. The prevalence of suicidal ideation increased with seniority among employees. Limitations: The study design was cross-sectional. Conclusion: The studied employment variables may have little effect on suicidal ideation. As suicidal ideation is a risk factor for suicide, more research is needed to explore the work-related risk factors for suicide and suicidal ideation.