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In most countries, men complete suicide at twice the rate of women; masculinity plays an important role in placing men at a greater risk of suicide. This study identifies and describes trends in the topics discussed within the masculinity and suicide literature and explores changes over time. We retrieved publications relating to masculinity and suicide from eight electronic databases and described origins in the field of research by reference to the first decade of publications. We then explored the subsequent evolution of the field by analysis of the content of article titles/abstracts for all years since the topic first emerged, and then separately by three epochs. We included 452 publications (1954–2021); research output has grown substantially in the last five years. Early publications framed suicide in the context of severe mental illness, masculinity as a risk factor, and suicidality as being aggressive and masculine. We observed some differences in themes over time: Epoch 1 focused on sex differences in suicidality, a common theme in epochs 2 was relationship to work and its effect on men's mental health and suicidality, and epoch 3 had a focus on help-seeking in suicidality. The research field of masculinity and suicide is growing strongly, as evidenced by recent increase in publication volume. The structure, content and direction of the masculinity and suicide research are still evolving. Researchers must work with policymakers and practitioners to ensure that emerging findings are translated for use in programs designed to address suicide in boys and men. Masculinity and suicide as a field is not new, with its origins in the literature dating back to 1954. More than half of the total research output in the field (1954–2021) has been published in the last five years. Early work focused on individual-level risk factors to male suicide (e.g., severe mental illness), while contemporary research focused on social and cultural determinants of male suicide (e.g., help-seeking). [ABSTRACT FROM AUTHOR]

Research is imperative to advance our understanding of suicidal behavior and its prevention. Suicide prevention research involves various ethical issues, many of which are not straightforward to address. Hence, suicide prevention researchers sometimes face particular issues when designing their research studies. This expert consensus study aimed to identify the most important ethical issues to consider when designing suicide prevention studies. People with lived experience of suicide (N = 32) and suicide prevention researchers (N = 34) rated 80 statements on a 5-point Likert scale from "essential" to "should not be included." There was significant agreement between and within the two groups of participants with regard to the most highly rated statements. The most highly rated statements for both groups included the importance of the ethical principles of merit, integrity, justice, and beneficence. Additionally, lived experience participants placed emphasis on the support and care for researchers, and suicide prevention researchers placed emphasis on the risk management protocols and support services for participants. There was strong agreement between people with lived experience of suicide and suicide prevention researchers regarding what to consider when designing ethically sound suicide prevention research, including the importance of ethical principles and support for both participants and researchers. There was strong agreement between people with lived experience of suicide and researchers. Researchers emphasized adherence to national guidelines. People with lived experience of suicide valued care for study participants and researchers. [ABSTRACT FROM AUTHOR]

Experiencing a death by suicide is a devastating event in the lives of adolescents; however, little is known about what makes help helpful according to their experiences. Thematic analysis of individual and group interview data (N = 18) yielded four themes: feeling connected with, and understood by a helper, having a sense of control over, and access to the help as needed. Findings indicate that help should be based on supportive and educational approaches with respect to the adolescents' agency and the family context. Help must be accessible on a long-term basis while catering for flexible usage. [ABSTRACT FROM AUTHOR]

Emerging data from high and upper-middle-income countries indicate that suicide rates generally did not increase during the initial months of the COVID-19 pandemic, yet the pandemic's impact on suicide is complex. We discuss the nuances of this relationship, how it may evolve over time, and describe the specific steps that governments and societies must take to mitigate harm and prevent suicides in the late stages and aftermath of the pandemic. [ABSTRACT FROM AUTHOR]

People at risk of suicide frequently communicate suicidal thoughts to professionals and non-professionals. These groups, therefore, need to be aware of how best to respond. We aimed to identify helpful and unhelpful responses to communications of suicide risk from the perspective of those at risk to inform suicide prevention messaging and education. We conducted an online survey (n = 141) of members of an online reference group for an Australian mental health organisation with a history of suicide risk. Most respondents had repeatedly considered and attempted suicide. Indirect suicide communications were more common than direct communications. Listening without judgement was the most common helpful response and "minimizing" responses to suicidal thoughts and feelings, the most common unhelpful responses. We make recommendations for suicide prevention messages and professional education content based on these findings. [ABSTRACT FROM AUTHOR]

Background: Youth suicide is a major public health concern worldwide. Public service announcements (PSAs) may have a role in suicide prevention, as part of broader suicide prevention campaigns.Method: We conducted a double-blind four arm randomized controlled trial in which 18 to 24 year olds were allocated to watch one of three suicide prevention PSAs intervention PSAs or a control PSA. Participants provided data prior to viewing their allocated PSA and again four weeks after viewing it. Our primary outcome was a change in participants' attitudes toward the preventability of suicide, and analysis was conducted on an intention-to-treat basis.Results: A total of 349 participants were randomized to one of four groups and 266 participants provided pre and post viewing data. Across the four groups, no significant change was observed in our primary outcome: attitudes toward the preventability of suicide (p = .455). There were also no differences between groups on secondary outcomes, namely other attitudes toward suicide (permissiveness, incomprehensibility, avoidance and loneliness), risk taking behavior, levels of distress, suicidal ideation, and likelihood of help-seeking and actual help-seeking.Conclusion: Our study has highlighted that attitudes and help-seeking intentions in young adults are difficult to change with low intensity one-off exposure to PSA messages. Further research is required to understand the factors that contribute to safe and effective messaging about suicide prevention. [ABSTRACT FROM AUTHOR]

The objective of the study was to determine whether people who died by suicide form groups based on demographic, psychosocial, mental and physical health factors and exposure to stressors. A retrospective case series review of 2,839 individuals who died by suicide in Victoria, Australia over the period 2009-2013 was conducted. A two-stage cluster analysis was performed. Diagnosis of mental illness was present in 52% of cases and initial cluster analysis determined two groups with the main predictor of group membership being the presence of diagnosed mental illness. Further analysis identified four subgroups within the mental illness group and two within the non-mental illness group. The study demonstrates that suicide does not always occur in the context of mental illness; people who die by suicide cannot be considered a homogenous group. [ABSTRACT FROM AUTHOR]

Objective:Man Up is a three-episode documentary in which Sydney radio personality, Gus Worland, explores the relationship between masculinity and suicide. Our evaluation of Man Up suggested that it changed attitudes, intentions and behaviours that place men at risk. This paper aimed to identify the 'active ingredients' responsible for these outcomes. Method: We analysed comments from those who had participated in a randomised controlled trial (RCT) or an online survey as part of our evaluation or had emailed us via the Man Up website. We also analysed reactions to Twitter and Facebook posts about the show. We ranked the top five themes emerging from each data source. Results: Particular scenes seem to strike a chord with audiences (e.g. a workshop with high school boys, the development/screening of a campaign ad called Man Up, Speak Up). The emphasis on men showing emotion and facts and figures about male suicide also appear important, as do representation by rural men and those who have lost a man to suicide. Discussion: The above segments and topics have credibility as the 'active ingredients' of Man Up and could form the core of a shorter version of the show. Our findings have implications for others developing media-based mental health promotion programs for men too. They suggest that messaging is likely to achieve positive results if it relates to men in meaningful ways, recognises the societal pressures that operate on them, does not simplify complex issues like suicide, and combines heartfelt stories with scientific data. [ABSTRACT FROM AUTHOR]

Suicide prevention media campaigns are gaining traction as a means of combatting suicide. The current review set out to synthesize information about the effectiveness of these campaigns. We searched four electronic databases for studies that provided evidence on the effectiveness of media campaigns. We focused on studies that described an evaluation of the effectiveness of an entire campaign or a public service announcement explicitly aimed at suicide prevention. We identified 20 studies of varying quality. Studies that looked at whether campaign exposure leads to improved knowledge and awareness of suicide found support for this. Most studies that considered whether campaign materials can achieve improvements in attitudes toward suicide also found this to be the case, although there were some exceptions. Some studies found that media campaigns could boost help-seeking, whereas others suggested that they made no difference or only had an impact when particular sources of help or particular types of help-seeking were considered. Relatively few studies had sufficient statistical power to examine whether media campaigns had an impact on the ultimate behavioral outcome of suicides, but those that did demonstrated significant reductions. Our review indicates that media campaigns should be considered in the suite of interventions that might be used to prevent suicide. Evidence for their effectiveness is still amassing, but there are strong suggestions that they can achieve positive results in terms of certain suicide-related outcomes. Care should be taken to ensure that campaign developers get the messaging of campaigns right, and further work is needed to determine which messages work and which ones do not, and how effective messages should be disseminated. There is an onus on those developing and delivering campaigns to evaluate them carefully and to share the findings with others. There is a need for evaluations that employ rigorous designs assessing the most pertinent outcomes. These evaluations should explore the nature of given campaigns in detail - in particular the messaging contained within them - in order to tease out which messages work well and which do not. They should also take into account the reach of the campaign, in order to determine whether it would be reasonable to expect that they might have their desired effect. [ABSTRACT FROM AUTHOR]

Objective: Despite growing awareness of adverse mental health consequences, the scarce existing evidence on the link of disaster exposure and suicidality has remained inconclusive, and the differential suicidality risk associated with distinct levels of natural and man-made disaster exposure is unknown. We therefore investigated the lifetime prevalence and risk of suicidal behavior associated with natural and man-made disaster exposure in Australia. Method: We utilized data from a nationally representative mental health survey (n = 8,841). Univariate and multivariate logistic regression analyses examined the lifetime risk of suicidal thoughts, plans, and attempts associated with varied types and levels of disaster exposure. We focused explicitly on natural and man-made disasters while controlling for other types of trauma exposure, including established risk factors for suicidality. Results: Multivariate analyses indicated that those exposed to multiple natural (adjusted odds ratio [AOR] = 2.21, 95% confidence interval [CI] = [1.04, 4.71], p < .05) or man-made disasters (AOR 3.4, 95% CI = [1.20, 9.58] p < .05) were at significantly greater risk of making suicide attempts, whereas single natural or man-made disaster exposure was not associated with an increased risk of suicidal behavior. Conclusions: Our study findings establish the differential suicidality risk associated with natural and man-made disaster exposure in Australia and highlight the critical role of repeat disaster exposure across distinct disaster types. Suicidal behavior may warrant increasing attention in psychosocial recovery schemes, particularly in the context of disaster-prone areas and for population groups at elevated risk of repeat disaster exposure. [ABSTRACT FROM AUTHOR]

The study replicates earlier research using a UK sample to examine differences between suicidal people who go online for suicide-related reasons and suicidal people who do not, perceived effects of suicide-related Internet use, and perceived barriers to offline help-seeking. A total of 72 UK citizens (18-24 years old) who had contemplated killing themselves or deliberately harmed themselves with the intention of dying within the past 12 months participated in an anonymous online survey. Results indicate that suicidal young people who use the Internet for suicide-related purposes are a high-risk group characterized by higher levels of social anxiety. The main purposes of suicide-related Internet use were to connect with others and seek information. Both positive and negative effects were found. [ABSTRACT FROM AUTHOR]

Media campaigns have received increased attention as an intervention for combating suicide. Suicide prevention campaigns involving public service announcements (PSAs) have not been well described and have been subject to minimal evaluation. This study aimed to identify suicide prevention PSAs from around the world and analyze and describe their content. We searched the Internet for short, English-language PSAs that had been screened as part of suicide prevention campaigns and identified 35. Most commonly, these PSAs focused on the general population and/or people who might be at risk of suicide, and had a particular emphasis on young people. Almost 60% promoted open discussion about suicide, around 50% indicated that the life of a suicidal person was important, about 40% acknowledged the suffering associated with suicidal thoughts and feelings, about 25% stressed that suicide is preventable, and about 20% focused on the devastating impact of suicide for those left behind. Most PSAs promoted some sort of support for people at risk of suicide, usually a helpline or website. Although these messages appeared appropriate and practical there is a lack of research on the impact that they may have on people with varying degrees of suicide risk. Further work is needed to ensure that they are consistent with theories of behavior change, and that they are having their desired impacts. [ABSTRACT FROM PUBLISHER]

The importance of addressing health disparities experienced by boys and men reached tangible prominence in Australia with adoption of the 2010 National Male Health Policy and the establishment of a national longitudinal study on male health—Ten to Men. Ten to Men is based on a holistic model of health with a strong focus on social determinants and health and well-being over the life course. Given the life course focus, we set out to assess if health-related characteristics and the correlates of self-rated health differ across the life course among four sociologically defined generations of Australian males. While some differences in the correlates of good or excellent health were observed across generations, addressing obesity and depression appear to be important for improving the health of Australian males of all ages. [ABSTRACT FROM AUTHOR]

Objective: To describe the types of content available to people searching online for suicide methods. Method: A series of suicide and suicide method-related searches were conducted through Google, Yahoo, Bing, and Ask search engines. Results: Most sites provided information on suicide methods and included discussion of suicide methods between users. Explicit encouragement of suicide was rare. However, dismissive or hostile responses to individuals expressing suicidal feelings were common. Conclusions: Information on suicide methods is easily found online. Mental health organizations may need to direct more efforts towards educating and training the public on how to appropriately respond to suicidal people. [ABSTRACT FROM PUBLISHER]

Australia has been implementing routine outcome measurement in its specialized public sector mental health services for over a decade. It uses a range of clinician-rated and consumer-rated measures that are administered at set times during episodes of inpatient, ambulatory and community residential episodes of care. Routine outcome measurement is now embedded in service delivery, and data are made available in a variety of ways to different audiences. These data are used by policy-makers and planners to inform decisions about system-wide reforms, by service managers to monitor quality and effectiveness, and by clinicians to guide clinical decision-making and to promote dialogue with consumers. Consumers, carers and the general community can use these data to ensure that services are accountable for the care they deliver. This paper describes the status quo in Australia with respect to routine outcome measurement, discusses the factors that led to its successful implementation, and considers the steps that are necessary for its continued development. [ABSTRACT FROM AUTHOR]

This paper presents the first attempt to provide a national snapshot of patient satisfaction with the Access to Allied Psychological Services (ATAPS) programme in Australia. ATAPS is funded by the Department of Health and Ageing and provides focussed psychological strategies to patients with common mental health disorders. At the time this work was done, ATAPS was managed locally by Divisions of General Practice; it is now managed by Medicare Locals. We emailed the 105 Divisions operating ATAPS inviting them to provide any survey instruments they had used to gauge patient satisfaction data, as well as any available data. Nine Divisions provided surveys and data. The content of the surveys varied considerably. Eight of the nine surveys included a question regarding overall satisfaction with the service and/or the service provider. However, there were few other commonalities between the surveys. In total, 1,142 of the 1,211 respondents who answered the question about overall satisfaction (94.3%) rated it as positive or very positive. Since this study took place, measurement of patient satisfaction has become a national requirement for all Medicare Locals providing ATAPS services. Assessment of patient satisfaction is especially relevant as ATAPS continues to strive to reach vulnerable and hard-to-reach populations. Recommendations are made to assist Medicare Locals, and other systems of primary mental health care provision, in the further collection of patient satisfaction data. [ABSTRACT FROM AUTHOR]

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Objective: We examined the capacity of the disaster mental health workforce in Victoria, Australia, to provide the three evidence-supported intervention types of psychological first aid, skills for psychological recovery, and intensive mental health treatments. Method: Utilizing data from a cross-professional, state-level disaster mental health workforce survey ( n = 791), we developed composite capacity indicators (CCI) for each intervention and performed logistic regression analyses to examine key predictors of disaster mental health workforce capacity. Results: CCI profiles highlighted significant gaps in the disaster mental health capacity of Victorian providers, with only 32-42% able to deliver current best practice interventions. Key predictors of workforce capacity common and unique to interventions were highlighted. Conclusions: Key strategies to raise Victoria's disaster mental health workforce capacity should focus on targeted multilevel training in best practice interventions, creation of practice opportunities, and structural provider support/engagement. CCIs focused on best practice interventions provide a methodology for rapid workforce capacity assessment that can facilitate disaster preparedness planning, capacity building, and delivery of quality disaster mental health services. [ABSTRACT FROM AUTHOR]

From July 2008 to June 2011, 19 Australian Divisions of General Practice piloted specialist services for consumers at risk of suicide within a broader primary mental health program. General practitioners and other mental health staff referred suicidal consumers to specially trained mental health professionals for intensive, time-limited care. To report the findings from an evaluation of the pilot. Data sources included a purpose-designed minimum data set, which collated consumer-level and session-level data, and a series of structured telephone interviews conducted with Divisional project officers, referrers and mental health professionals. There were 2312 referrals to the pilot; 2070 individuals took up the service. The pilot reached people who may not otherwise have had access to psychological care; over half of those who received services were on low incomes and about one-third had not previously accessed mental health care. Project officers, referrers and mental health professionals were all positive about the pilot and commented that it was meeting a previously unmet need. Consumers appeared to benefit, showing significant improvements in outcomes. This evaluation provides supportive evidence for the effectiveness of a suicide prevention intervention delivered by specially trained mental health professionals in a primary mental health environment. [ABSTRACT FROM AUTHOR]

This paper presents the results of a summative evaluation of the training component of the Australian Government Mental Health Response to the 2009 bushfires in Victoria, Australia. With very little evidence available to date on comprehensive attempts at implementing multilevel training frameworks in the wake of natural disasters, the evaluation provides valuable insights into an effort that sought to build the capacity of practitioners to respond to the psychosocial and mental health consequences of a significant bushfire disaster at various levels of the response system. Key findings of the evaluation are discussed with regards to their relevance for the training of mental health practitioners in a broader range of disaster circumstances. [ABSTRACT FROM AUTHOR]

Background: Economic evaluation of individual interventions can have limited usefulness due to the potential for methodological confounding, particularly for those decision contexts where strategies involving multiple interventions are required. Aims: To introduce readers to different approaches of priority-setting, with a focus on economics-based examples of priority-setting in mental health. Method: A selective review of the priority-setting literature, with particular attention given to the mental health context and economics-based approaches. Results: Six priority-setting approaches in mental health are described and assessed. Conclusions: Priority-setting approaches that incorporate methodological rigour, due process for involving stakeholders and broad-based notions of 'benefit', are likely to be of most use to mental healthcare decision-makers. Challenges, both in relation to data bases and method remain, but are within the capacity of the mental health research community to resolve. [ABSTRACT FROM AUTHOR]

The Australian Government's Better Access initiative was introduced in late 2006 to increase treatment rates for people with mental disorders. It provides for reimbursement of psychologists' services through Medicare. The current pilot study examines the experiences of psychologists with this initiative. A random sample of 204 of 4,235 psychologists in private practice was approached and 73 psychologists (36%) were interviewed. The current study suggests that psychologists have had positive experiences with Better Access. They have appreciated the greater security of income and greater variety of work afforded by the initiative, and they have observed flow-on benefits in terms of increased access and reduced stigma for their clients. Additional research is required to corroborate these findings with a larger sample of psychologists, but the current findings provide indicative evidence that Better Access is assisting psychologists to meet a previously unmet community need for mental health care. [ABSTRACT FROM AUTHOR]

Background: The Australian Better Outcomes in Mental Health Care (BOiMHC) program commenced in 2001, with the aim of improving primary mental healthcare delivery. One component of the BOiMHC program involves 108 Access to Allied Psychological Services (ATAPS) projects which enable GPs to refer patients to allied health professionals for low-cost, evidence-based care. The projects have improved access to psychological care, but referrals are outstripping their capacity to provide psychological services. This study examined the demand management strategies that projects have used, and how well these strategies are working. Method: A survey was emailed to the project officers of the 108 ATAPS projects. Results: The most commonly used demand management strategies were: informing/training GPs; putting in place systems and/or administrative procedures; and monitoring and limiting referrals. Most projects used combined broad demand management strategies, employing many approaches within each strategy. Monitoring and limiting referrals and putting in place systems and/or administrative procedures were ranked as the most useful. Demand strategies were underpinned by strong partnerships and solid infrastructure. Conclusion: The ATAPS projects are using demand management strategies. Strategies tend to be supply-side strategies instituted where the patient makes contact with the GP and/or approaches the GP-allied health professional interface, rather than demand-side strategies aimed at the patient-practice interface. Strategies appear to be working well when supported by collaborations and infrastructure. The need for demand management strategies reflects resourcing issues that impact on providers' morale and patients' satisfaction. Findings are discussed in relation to other recent developments in Australian primary mental healthcare. [ABSTRACT FROM AUTHOR]

The aim of this paper was to consider the impact on psychologists of one component of the Australian Government's Better Outcomes in Mental Health Care (BOiMHC) program, namely the Access to Allied Psychological Services (ATAPS) component. This supports psychologists and general practitioners (GPs) to work together to provide optimal mental health care, via 102 projects being conducted by Divisions of General Practice. The paper was informed by data from five sources: a project-based minimum dataset; local project evaluation reports; a forum; a survey of projects; and a survey of Australian Psychological Society (APS) members. Taken together, the data from these sources showed that a significant number of psychologists are providing services through the projects, and the majority are finding it a positive and professionally rewarding experience. There is considerable variability regarding models of retaining, locating and referring to psychologists, and there are pros and cons associated with each. The major problem identified by psychologists is the level of remuneration. BOiMHC is currently moving into a new phase of continuation and expansion, and consideration was given to whether the data point to any changes that could be made to the ATAPS projects during this period of transition. In the main, the data suggest that the status quo should be retained, but the issue of remuneration must be addressed. [ABSTRACT FROM AUTHOR]

This article reviews the published literature on the extent, nature, and impacts of portrayal of mental illness in fictional films and television programs. The literature suggests that on-screen portrayals are frequent and generally negative, and have a cumulative effect on the public's perception of people with mental illness and on the likelihood of people with mental illness seeking appropriate help. The article concludes that there is a need for the mental health sector and the film and television industries to collaborate to counter negative portrayals of mental illness, and to explore the potential for positive portrayals to educate and inform, as well as to entertain. [ABSTRACT FROM AUTHOR]

The article discusses the Mindframe National Media Initiative in Australia and its goal of assessing and intervening against copycat behavior associated with news media portrayals of suicide cases in newspapers and television. The authors discuss the Media Monitoring Project and the development of suicide reporting guidelines documented in the 2002 report "Reporting Suicide and Mental Illness." The applicability of the research to the broader health communication research field is discussed.

Background: Mental health care services play an important role following disasters (Reifels et al., 2013). The aim of this study is to examine patterns and predictors of primary mental health care service use, following two major Australian natural disaster events. Method: Utilizing referral and session data from a national minimum dataset, descriptive and regression analyses were conducted to identify levels and predictors of the use of the Access to Allied Psychological Services (ATAPS) program over a 2-year period following two major Australian bushfire and flood/cyclone disasters. Predictor variables examined in negative binomial regression analysis included consumer (age, gender, household structure, previous mental health care history, and diagnosis) and event characteristics (disaster type). Results: The bushfire disaster resulted in significantly greater service volume, with more than twice the number of referrals and nearly three times the number of sessions. Service delivery for both disasters peaked in the third quarter. Consumers affected by bushfires, diagnosed with depression, anxiety, or both of these disorders utilized sessions at significantly higher rates. Conclusions: The substantial demand for primary mental health services following disaster can vary with disaster type. Disaster type and need-based variables as key drivers of service use intensity indicate an equitable level of service use. Established usage patterns assist with estimating future service capacity requirements. Flexible referral pathways can enhance access to disaster mental health care. Future research should examine the impact of program- and agency-level factors on mental health service use and factors underpinning treatment non-adherence following disaster. [ABSTRACT FROM AUTHOR]