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Background: Little is known regarding those who die by suicide without having received help. The aim of this study was to compare those who died by suicide without having attended psychiatric care with controls (a) with a psychiatric diagnosis and (b) from the general population., Methods: Cases were all individuals 15+ who lived in Denmark during 2010-2021 and had died by suicide without having attended hospital-based psychiatric care. Cases were matched to controls from the two comparison-groups using a 1:10 ratio and compared using age-and sex-adjusted logistic regression analyses. Geographical variations in psychiatric care utilization were examined., Results: Among 7119 individuals who died by suicide, 3474 (48.8 %) had not attended psychiatric care. Compared to controls with a psychiatric diagnosis, cases were more likely to be male (OR, 3.9, 95% CI, 3.6-4.2), older (80+ years: OR, 10.7, 95 % CI, 9.2-12.5), have lost a close relative (OR, 1.8, 95 % CI, 1.3-2.6) or recently retired (OR, 1.4, 95 % CI, 1.0-1.1.8). Compared to controls from the general population, cases were associated with male sex (OR, 4.6, 95 % CI, 4.2-5.0), living alone (OR, 2.3, 95 % CI, 2.2-2.5), unemployment (OR, 2.1, 95 % CI, 1.8-2.5), as well as having lost a close relative (OR, 5.0, 95 % CI, 3.5-7.2) or divorced within the last 1 year (OR, 3.6, 95 % CI, 2.7-4.9)., Limitations: Characteristics and preceding events were limited to available register data., Conclusions: About half of all who died by suicide had not attended psychiatric care. Being older, male, or exposed to recent stressors were some of the major markers when compared to controls., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Two of the most common modifiable barriers to help-seeking for mental health problems during adolescence are stigma and poor mental health literacy. However, relatively little is known about stigma as it relates to suicide, and knowledge about suicidality in this age group., Aims: To assess levels of suicide literacy and suicide attitudes in an adolescent sample, and to identify correlates of these constructs., Methods: Data were drawn from the pre-intervention survey of the Sources of Strength Australia Project. A total of 1019 adolescents aged between 11 and 17 years participated. Suicide literacy and attitudes were measured alongside potential correlates including psychological distress, suicidal ideation, mastery, previous exposure to suicidal thinking and behaviour, and demographics., Results: Participants more strongly endorsed attitudes attributing suicide to isolation/depression, compared to attitudes glorifying or stigmatising suicide. Gaps in knowledge about suicide included the risk factors, signs and symptoms. Key correlates of suicide attitudes and literacy included age, gender and cultural background., Conclusion: Findings highlight the need for further education activities in schools and public awareness campaigns that address the gaps in suicide knowledge and attitudes. Such activities would assist in the identification of suicide risk among young people and improve help-seeking in this population.

Suicide is the leading cause of death among Australian young people, yet rates of help-seeking for suicidal ideation and behaviors in this population are concerningly low. In this study, the relationships between parental suicide stigma, parental suicide literacy, and their attitudes and intentions toward seeking professional help for their child if they were to express thoughts of suicide are investigated. Understanding this influence is critical given parents are key facilitators of their child's access to and engagement with professional mental health services. An online survey was administered to 302 parents of children aged-12-18 (M age  = 45.36, SD age  = 6.23; 91.4% female). Parental suicide stigma was significantly associated with more negative help-seeking attitudes and lower help-seeking intentions. Other significant predictors of more positive help-seeking attitudes included parental self-efficacy and having a child with no history of suicidal ideation. Higher help-seeking intentions were associated with female gender, living in an urban area, and positive help-seeking attitudes. Parental suicide literacy was not significantly associated with help-seeking. Practically, outcomes of this study may inform the development and implementation of targeted education programs to increase parental help-seeking for their children., (© 2023. The Author(s).)

Objective: It is necessary for suicide prevention interventions to demonstrate safety. One important aspect of safety is evidence that deterioration rates are low. No studies have examined deterioration of suicidal ideation in the context of an internet-based cognitive behavioral therapy (CBT) intervention to reduce suicidal ideation. A secondary analysis of the outcomes of an online trial was conducted to determine rates of deterioration in a CBT intervention called Living with Deadly Thoughts, relative to an attention control condition, and to identify factors associated with deterioration., Method: The randomized controlled trial included 418 adults with suicidal ideation at baseline (77% females, mean age 40.6 years). Deterioration was defined in two ways: a reliable increase in Suicidal Ideation Attributes Scale (SIDAS score) of ≥6.0 units; or triggering the safety protocol during the trial as determined by high levels of suicidality. Analyses were repeated with multiply imputed data. Predictors of deterioration were identified using logistic regression analysis., Results: 30 (14%) participants in the control group and 15 (7%) in the intervention group met criteria for reliable deterioration (Fisher's exact p  = 0.027). In a fully adjusted logistic regression model, greater initial severity of suicidal thinking was associated with lower odds of deterioration, while intervention condition, demographics, psychological factors and mental health factors had no significant association with deterioration., Conclusions: Participation in an online suicide prevention intervention was associated with lower prevalence of reliable deterioration than participation in an attention-control intervention, providing further evidence that internet-based CBT interventions do not cause harm.HighlightsFirst study to assess deterioration in an internet suicide prevention interventionRates of reliable deterioration were higher in control (14%) than intervention (7%)No psychological or demographic factors were robustly associated with deteriorationFindings provide further evidence that internet based CBT programs are not harmful.

Background: Suicide is a significant public health problem and there is a clear need for interventions to improve help seeking for suicide and psychological distress in young people. This trial aimed to assess the effectiveness of the school-based Sources of Strength program in increasing help-seeking intentions and behaviours in adolescents., Methods: A cluster, randomised controlled trial was conducted in 13 Australian secondary schools (N = 1633), with each school randomly allocated to the intervention (n = 7) or wait-list control condition (n = 6). Participants in the intervention condition received the Sources of Strength program over two years and all participants completed self-report measures of help-seeking intentions and behaviour at four time-points. Staff and students in the intervention condition also provided qualitative feedback on the perceived impact of the program., Results: Mixed model repeated measures analyses demonstrated no significant effect of the Sources of Strength program on help-seeking intentions or behaviour at post-intervention or 6- or 18-month follow-up. Staff and students reported, through qualitative feedback, that the program increased awareness of and openness to help seeking and promoted a common language and school community., Limitations: The current study only included self-report measures that may have been influenced by situational factors or biases., Conclusions: Although the Sources of Strength program may have increased awareness of help seeking, there was no evidence that it is effective in increasing help-seeking intentions or behaviours in this cohort. The program may be more suitable for schools in disadvantaged areas where there may be limited existing connections to trusted adults., (Copyright © 2021 Elsevier B.V. All rights reserved.)

There is a growing body of evidence highlighting the presence of a single general dimension of psychopathology that can account for multiple associations across mental and substance use disorders. However, relatively little evidence has emerged regarding the validity of this model with respect to a range of factors that have been previously implicated across multiple disorders. The current study utilized a cross-sectional population survey of adolescents (n = 2,003) to examine the extent to which broad psychopathology factors account for specific associations between psychopathology and key validators: poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem. Confirmatory factor models, latent class models, and factor mixture models were estimated to identify the best structure of psychopathology. Structural equation models were then estimated to examine the broad and specific associations between each psychopathology indicator and the validators. A confirmatory factor model with three lower-order factors, representing internalizing, externalizing, and psychotic-like experiences, and a single higher-order factor evidenced the best fit. The associations between manifest indicators of psychopathology and validators were largely nonspecific. However, significant and large direct effects were found between several pairwise associations. These findings have implications for the identification of potential targets for intervention and/or tailoring of prevention programs.

Objective: To assess associations between physical, mental, and social well-being and suicide and self-harm in a community-based sample of older adults., Methods: Using a cohort design, questionnaire data from 102,880 individuals aged 65 years or older living in New South Wales, Australia during 2006-2009 were linked to hospital and cause-of-death databases until 2017. Poisson regressions obtained adjusted incidence rate ratios (IRRs)., Results: One hundred nine suicides and 191 deliberate self-harm (DSH) events occurred. Compared to those reporting excellent/good overall health, older adults reporting fair overall health had higher suicide rates (IRR = 2.8, 95% confidence interval: 1.8-4.4). Also, suffering from physical limitations was associated with higher rates of suicide. A fair versus excellent/good memory was associated with higher rates of suicide (IRR = 2.0, 1.3-3.3). Male erectile dysfunction was linked to self-harm (IRR = 2.8, 1.0-7.7). Suicide rates were elevated with baseline Kessler-10 scores of 20-50 versus 10-15 (IRR = 5.0, 2.9-8.9); the corresponding IRR for DSH was 2.9 (1.8-4.8). Elevated rates were observed for both self-reported depression and anxiety. Poor versus excellent/good quality of life was associated with suicide (IRR = 4.3, 1.7-10.7) and achieving less than desired to due to emotional problems was linked to self-harm (IRR = 1.8 1.3-2.4). Rates of suicide ande DSH were lower in those with ≥5 people to depend on versus one (suicide: IRR = 0.5, 0.3-0.9; DSH: IRR = 0.5, 0.3-0.7)., Conclusions: Older adults experiencing health problems, including those relating to overall health or memory, and those with psychological distress had elevated rates of suicidal behavior. Rates of subsequent self-harm and/or death by suicide were elevated in participants with small social networks., (© 2020 John Wiley & Sons Ltd.)

Purpose: The aim of this study was to examine the relation of mental, physical, and social wellbeing measures to death by suicide and self-harm (SH)., Methods: Using a cohort design, questionnaire data on 266,324 responders aged ≥ 45 years, living in NSW, Australia were linked to hospital and death databases during 2006-2017. Adjusted incidence rate ratios (IRR) were calculated., Results: Overall, 212 suicides and 723 SH episodes were observed. A dose-response relationship with suicidal behaviour was found for Kessler-10 Psychological Distress Scale; IRRs of 4.5 (95% CI 2.4-8.3) for suicide and 8.3 (95% CI 6.5-10.7) for SH were observed for scores of high versus low distress. Elevated rates were also observed for those reporting poor versus good or excellent health (suicide, IRR: 3.8, 95% CI 2.2-6.9; SH, IRR: 4.5 95% CI 3.4-6.1); being dependent versus not dependent on help with daily tasks (suicide, IRR: 2.4 95% CI 1.5-3.7; SH, IRR: 2.6 95% CI 2.0-3.3); being a current smoker (suicide, IRR: 1.8, 95% CI 1.1-2.9; SH, IRR: 2.9 95% CI 2.3-3.5) having versus not having male erectile problems (SH, IRR: 1.9 95% CI 1.4-2.5). Participants with ≥ 5 people versus one person to depend on had reduced suicidal behaviour (suicide, IRR: 0.5 95% CI 0.3-0.7, SH, IRR: 0.5 95% CI 0.4-0.6)., Conclusions: An active social network was linked to lower rates of suicide and self-harm. Adverse health, dependence on help, psychological distress were associated with higher rates of suicide and self-harm, while erectile problems were linked to an elevated rate of self-harm.

The current study aimed to compare the personal stigma of suicide with the personal stigma for other mental and physical health conditions. 116 Australian medical students (58% women), aged between 20 and 41 years ( M  = 25.02, SD  = 3.80), completed an online survey. Suicide was more highly stigmatized than most of the other mental and physical health conditions in both attitudes toward suicide and willingness to disclose. The current study highlights the need for further medical student education in suicide, as ongoing negative attitudes could negatively affect patient care and disclosure.

Background: Depression is a risk factor for suicidal ideation. However, suicidal ideation can occur in the absence of depression and treating depression may not reduce suicidal thinking. This study tested whether trajectories of suicidal thinking are concordant with trajectories of depressive symptoms and sought to identify factors associated with these trajectories., Methods: Participants were community-based Australian adults (N = 418, 77% female) enrolled in a randomized controlled trial evaluating the effectiveness of an online cognitive-behavioral intervention for suicidal ideation. Separate linear growth mixture models were estimated across 12 months of follow-up to identify longitudinal trajectories of suicidal ideation and depression symptoms. Predictors of latent class membership were tested using logistic regression models., Results: Two-class models were found to have optimal fit for both suicidal thinking and depressive symptoms. Trajectory classes of suicidal ideation were: (1) moderate severity decreasing over time; and (2) high severity remaining stable over time. Depression trajectories were: (1) moderate severity with a small decrease over time; and (2) high severity that decreased moderately over time. Lower perceived burdensomeness was associated with having a greater decrease in both suicidal thinking and depression. More severe mental health symptoms were associated with less decrease in depression symptoms but not with suicidal ideation trajectory., Conclusion: Class membership across the two outcomes and predictors of class membership were found to be largely independent. The lack of coupling in trajectories and predictors suggests that changes in suicidal thinking may occur independently of changes in depression., (© 2018 Wiley Periodicals, Inc.)

It remains unclear whether the Interpersonal Psychological Theory of Suicide (IPTS; Joiner, ) is generalizable to the population or holds more explanatory power for certain subgroups compared to others. The aim of this study was to (1) identify subgroups of individuals who endorsed suicide ideation in the past month based on a range of mental health and demographic variables, (2) compare levels of the IPTS constructs within these subgroups, and (3) test the IPTS predictions for suicide ideation and suicide attempt for each group. Latent class, negative binomial, linear, and logistic regression analyses were conducted on population-based data obtained from 1,321 adults recruited from Facebook. Among participants reporting suicide ideation, four distinct patterns of risk factors emerged based on age and severity of mental health symptoms. Groups with highly elevated mental health symptoms reported the highest levels of thwarted belongingness and perceived burdensomeness. Tests of the IPTS interactions provided partial support for the theory, primarily in young adults with elevated mental health symptoms. Lack of support found for the IPTS predictions across the subgroups and full sample in this study raise some questions around the broad applicability of the theory., (© 2018 The American Association of Suicidology.)

Background: Suicide is a leading cause of death worldwide. Identifying those at risk and delivering timely interventions is challenging. Social media site Twitter is used to express suicidality. Automated linguistic analysis of suicide-related posts may help to differentiate those who require support or intervention from those who do not., Aims: This study aims to characterize the linguistic profiles of suicide-related Twitter posts., Method: Using a dataset of suicide-related Twitter posts previously coded for suicide risk by experts, Linguistic Inquiry and Word Count (LIWC) and regression analyses were conducted to determine differences in linguistic profiles., Results: When compared with matched non-suicide-related Twitter posts, strongly concerning suicide-related posts were characterized by a higher word count, increased use of first-person pronouns, and more references to death. When compared with safe-to-ignore suicide-related posts, strongly concerning suicide-related posts were characterized by increased use of first-person pronouns, greater anger, and increased focus on the present. Other differences were found., Limitations: The predictive validity of the identified features needs further testing before these results can be used for interventional purposes., Conclusion: This study demonstrates that strongly concerning suicide-related Twitter posts have unique linguistic profiles. The examination of Twitter data for the presence of such features may help to validate online risk assessments and determine those in need of further support or intervention.

Context: Since the development of the Interpersonal Psychological Theory (IPTS; Joiner, 2005), a growing body of literature has emerged testing different aspects of the theory across a range of populations., Objective: The aim of this review was to identify support for the IPTS, and critical gaps in the evidence base, by systematically reviewing current evidence testing the effects of thwarted belongingness, perceived burdensomeness, and acquired capability on suicide ideation and attempt., Methods: PsycInfo and PubMed databases were electronically searched for articles published between January 2005 and July 2015. Articles were included if they directly assessed the IPTS constructs as predictors of suicidal ideation or suicide attempt., Results: Fifty-eight articles reporting on 66 studies were identified. Contrary to expectations, the studies provided mixed evidence across the theory's main predictions. The effect of perceived burdensomeness on suicide ideation was the most tested and supported relationship. The theory's other predictions, particularly in terms of critical interaction effects, were less strongly supported., Conclusions: Future research focused on expanding the availability of valid measurement approaches for the interpersonal risk factors, and further elaborating upon their mixed relationships with suicide ideation and attempt across multiple populations is important to advance theoretical and clinical progress in the field., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: A systematic review was conducted to identify the impact of intimate partner relationships on suicidality. The aim of the review was to identify factors within intimate partner relationships that influence suicidal ideation, attempts and completion., Method: Fifty-one articles were identified through Scopus, PubMed and PsycINFO databases. Due to the high heterogeneity of the included studies, a narrative data synthesis was conducted., Results: The research drew attention to specific contingents of the population, for example examining suicide risk in individuals under the age of 35 or lesbian, gay, bisexual and transgender (LGBT) individuals who are experiencing relationship discord, and in males who have recently separated., Limitations: Interpretation of these findings is constrained by methodological limitations prevalent in much of the literature. Limitations of the existing literature and corresponding directions for future research are discussed., Conclusions: Relationship separation and poor quality relationships are likely to be important risk factors for suicidal thoughts and behaviours and are frequent triggers for a suicide attempt. This review highlights intimate partner relationships as a significant component in a suicide risk assessment, regardless of the clinical setting. Consequently, clinicians should be aware that individuals reporting relationship problems are likely to be at increased risk of suicidal thoughts and behaviours., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The interpersonal-psychological theory of suicidal behavior suggests that the combination of perceived burdensomeness and thwarted belongingness predicts suicidal ideation. However, the specificity of this prediction to suicidal ideation has not been tested. This study examined whether these constructs were consistently associated with different characteristics of suicidal ideation, and whether they were associated with mental health problems more broadly, in an online sample of 1,352 Australian adults. Findings indicated that the interaction between perceived burdensomeness and thwarted belongingness was associated only with suicidal ideation and consistent across multiple characteristics of ideation. The study broadly supported the specificity of the IPTS., (© 2014 The American Association of Suicidology.)

Divorce has been identified as a risk factor for suicide. However, little research has been conducted on the time trajectory of the influence of relationship separation on suicidal outcomes. This study aimed to assess the effects over time of relationship breakdown and separation on suicidality. Data were drawn from 6616 Australian adults participating in the PATH through Life Project, a population-based longitudinal study. Suicidal ideation was reported by 406 participants (6.1%), and 99 (1.5%) reported a suicide plan or attempt in the past year. The effects of separation on suicidality were strongest soon after separation, with a nearly three-fold increase in ideation (adjusted OR = 2.73, p < 0.001) and an eight-fold increase in plans/attempts (adjusted OR = 7.75, p < 0.001) in the two years following separation, gradually diminishing subsequently. The period up to four years before a separation was also found to be a time of increased risk for suicidal thoughts and behaviours, while marriage was protective. Separation is a strong risk factor for suicidality and mental health services should target recently separated individuals., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Research in suicide prevention using psychosocial interventions is rapidly advancing. However, randomised controlled trials are published across a range of medical, psychological and sociology journals, and it can be difficult to locate a full set of research studies. In this paper, we present a database of randomised controlled outcome studies on psychosocial interventions targeting suicidal behaviour. The database is updated annually and can be accessed by contacting the corresponding author., Description: A comprehensive literature search of the major bibliographical databases (PsycINFO; PubMed; Cochrane Central Register of Controlled Trials) was conducted for articles published between 1800 to July 30 2013, and examined reference lists of previous relevant reviews and included papers to locate additional references. Studies were included if they featured a randomised controlled design in which the effects of a psychosocial intervention were compared to a control condition (no intervention, attention placebo, wait-list, treatment-as-usual [TAU]), another psychosocial intervention or a pharmacological intervention. In total, 12,250 abstracts were identified. Of these, 131 studies met eligibility criteria and were included. Each paper was then coded into categories of participant characteristics (age, gender, formal diagnosis, primary reason for recruitment); details of the intervention (recruitment setting, content, intervention setting, administering individual, delivery type, delivery format, delivery frequency, delivery length); and study characteristics (control and experimental conditions, primary outcome/s, secondary outcome/s, follow-up period). One paper has been published from the database using studies collected and coded prior to 2012., Conclusion: The database and listing of 131 studies is available for use by suicide prevention researchers. It provides a strong starting point for systematic reviews and meta-analyses of treatments and interventions. It will be updated yearly by researchers funded through the Australian National Health and Medical Research Council Centre for Research Excellence for Suicide Prevention (CRESP), located at the Black Dog Institute, Australia. This database adds to the evidence base of best-practice psychosocial interventions for suicidal behaviour and prevention.

Public knowledge and attitudes toward suicide may influence help-seeking for suicidality. This study aimed to identify correlates of suicide attitudes and knowledge. Australian adults were invited to complete an online survey, with 1,286 responders. Less exposure to suicide, older age, male gender, less education, and culturally diverse backgrounds were associated with poorer knowledge; while younger age, male gender, and culturally diverse backgrounds were associated with more stigmatizing attitudes toward people who die by suicide. The results suggest suicide literacy and stigma reduction programs would benefit community members, particularly males and individuals from culturally diverse backgrounds., (© 2013 The American Association of Suicidology.)

Background: There are presently no validated scales to adequately measure the stigma of suicide in the community. The Stigma of Suicide Scale (SOSS) is a new scale containing 58 descriptors of a "typical" person who completes suicide., Aims: To validate the SOSS as a tool for assessing stigma toward suicide, to examine the scale's factor structure, and to assess correlates of stigmatizing attitudes., Method: In March 2010, 676 staff and students at the Australian National University completed the scale in an online survey. The construct validity of the SOSS was assessed by comparing its factors with factors extracted from the Suicide Opinion Questionnaire (SOQ)., Results: Three factors were identified: stigma, isolation/depression, and glorification/normalization. Each factor had high internal consistency and strong concurrent validity with the Suicide Opinion Questionnaire. More than 25% of respondents agreed that people who suicided were "weak," "reckless," or "selfish." Respondents who were female, who had a psychology degree, or who spoke only English at home were less stigmatizing. A 16-item version of the scale also demonstrated robust psychometric properties., Conclusions: The SOSS is the first attitudes scale designed to directly measure the stigma of suicide in the community. Results suggest that psychoeducation may successfully reduce stigma.