Melbourne School of Population and Global Health - Research Publications
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ItemEthical Concerns in Suicide Research: Results of an International Researcher Survey(SAGE PUBLICATIONS INC, 2019-10)Researchers and research ethics committees share a common goal of conducting ethically sound research. However, little is known of researchers' experiences in obtaining ethics approval for suicide-related studies. This study aimed to investigate what concerns researchers have received on suicide-related ethics applications and how they dealt with it. Thirty-four respondents, recruited through the International Association for Suicide Prevention, filled out an online survey. The study found that researchers have received important concerns regarding potential harm and researchers' responsibilities to participants. Researchers modified their application and/or consulted their research ethics committee in response to the concerns, which had a positive/neutral impact on their given study. Anticipating concerns and improved collaboration between researchers and research ethics committees should protect the quality of suicide prevention research.
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ItemClusters of Suicidal Events Among Young People: Do Clusters from One Time Period Predict Later Clusters?(WILEY, 2019-04)We sought to compare clusters of suicidal events between two different time periods and examine the extent to which earlier clusters predict later clusters. We included data on suicides and suicide attempts from New South Wales between July 2001 and June 2012 and Western Australia between January 2000 and December 2011. Suicide attempts included admissions to hospital for deliberate self-harm and suicides were deaths due to deliberate self-harm. We combined data on suicides and suicide attempts and grouped them into two equal time periods. We detected clusters in each period using Poisson discrete scan statistics adjusted for socio-economic status. We estimated the predictive values of earlier clusters on later clusters. The results showed that clusters from earlier time period had a moderate power (36%) in predicting later clusters. During the later time period, some additional cluster areas (14%) were found and some earlier cluster areas subsided (64%). Historical clusters predict 36% of the subsequent clusters, which is probably not sufficient for targeting interventions. Our study highlights the need for other strategies to detect emerging clusters, for example, up-to-date data.
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ItemWhat Works in Youth Suicide Prevention? A Systematic Review and Meta-Analysis(ELSEVIER, 2018)BACKGROUND: Young people require specific attention when it comes to suicide prevention, however efforts need to be based on robust evidence. METHODS: We conducted a systematic review and meta-analysis of all studies examining the impact of interventions that were specifically designed to reduce suicide-related behavior in young people. FINDINGS: Ninety-nine studies were identified, of which 52 were conducted in clinical settings, 31 in educational or workplace settings, and 15 in community settings. Around half were randomized controlled trials. Large scale interventions delivered in both clinical and educational settings appear to reduce self-harm and suicidal ideation post-intervention, and to a lesser extent at follow-up. In community settings, multi-faceted, place-based approaches seem to have an impact. Study quality was limited. INTERPRETATION: Overall whilst the number and range of studies is encouraging, gaps exist. Few studies were conducted in low-middle income countries or with demographic populations known to be at increased risk. Similarly, there was a lack of studies conducted in primary care, universities and workplaces. However, we identified that specific youth suicide-prevention interventions can reduce self-harm and suicidal ideation; these types of intervention need testing in high-quality studies.
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ItemDealing with Ethical Concerns in Suicide Research: A Survey of Australian Researchers(MDPI, 2019-04-01)Given the increasing trend in suicide mortality and its burden on individuals, families and communities, ethically sound research is crucial to improve the prevention of suicidal behaviour. However, few studies have looked at the experiences of researchers in obtaining ethics approval for their studies. This study addressed this gap by investigating researchers' experiences in obtaining ethics approval and how they dealt with the concerns raised by ethics committees. Respondents were recruited from September to November 2018 through the Australian Suicide Prevention Research Leaders Network, and 33 respondents (35%) completed the study survey, comprising forced-choice and open-ended questions. Respondents most commonly reported concerns from ethics committees regarding potential harm to participants and researchers' responsibilities to participants within the context of intervention and evaluation studies. Most researchers modified their ethics application and/or consulted with their ethics committee to reply to the concerns raised. Most respondents perceived the impact of the modification as positive or neutral. The study concludes that researchers may anticipate potential concerns of ethics committees. Improved understanding of how ethics committees work and dialogue between researchers and ethics committees should sustain the quality in suicide-related research.
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ItemEffectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes(BMC, 2019-01-30)BACKGROUND: Suicide bereavement is a risk factor for adverse outcomes related to grief, social functioning, mental health and suicidal behaviour. Consequently, suicide bereavement support (i.e., postvention) has been identified as an important suicide prevention strategy. However, little is known about its effectiveness. To redress this gap, this review aimed to assess the evidence of effectiveness of interventions for people bereaved by suicide, and appraise the quality of the research in this field. METHODS: We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, PsycINFO, Embase and EBM Reviews identified 12 papers reporting on 11 relevant studies conducted between 1984 and 2018. RESULTS: Across studies, there was a wide variety of intervention modalities, study populations, control groups, and grief, psychosocial and suicide-related outcome measures. Overall, the quality of studies was weak. While there was some evidence of the effectiveness of interventions for uncomplicated grief, evidence of the effectiveness of complicated grief interventions was lacking. Based on this scant evidence, interventions which seem to show promise include supportive, therapeutic and educational approaches, involve the social environment of the bereaved, and comprise a series of sessions led by trained facilitators. CONCLUSIONS: There is a clear need for additional methodologically sound studies in this area. Specifically, selection procedures, sample sizes, randomization, and the use of appropriate measures are crucial. As people bereaved by suicide are at-risk of adverse grief, mental ill-health and suicidal behaviour, further research across the life-span is essential to prevent grief and mental health ramifications.
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ItemThe #chatsafe project. Developing guidelines to help young people communicate safely about suicide on social media: A Delphi study(PUBLIC LIBRARY SCIENCE, 2018-11-15)INTRODUCTION: Many countries have developed guidelines advocating for responsible reporting of suicidal behaviour in traditional media. However, the increasing popularity of social media, particularly among young people, means that complementary guidelines designed to facilitate safe peer-peer communication are required. The aim of this study was to develop a set of evidence informed guidelines to assist young people to communicate about suicide via social media with the input of young people as active participants of the study. METHODS: Systematic searches of the peer-reviewed and grey literature were conducted resulting in a 284-item questionnaire identifying strategies for safe communication about suicide online. The questionnaire was delivered over two rounds to two panels consisting of Australian youth advocates; and international suicide prevention researchers and media and communications specialists. Items were rerated if they were endorsed by 70-79.5% of both panels, or if 80% or more of one panel rated the item as essential or important. All items that were endorsed as essential or important by at least 80% of both panels were included in the final guidelines. RESULTS: A total of 173 items were included in the final guidelines. These items were organised into the following five sections: 1) Before you post anything online about suicide; 2) Sharing your own thoughts, feelings, or experience with suicidal behaviour online; 3) Communicating about someone you know who is affected by suicidal thoughts, feelings or behaviours; 4) Responding to someone who may be suicidal; 5) Memorial websites, pages and closed groups to honour the deceased. DISCUSSION: This is the first study to develop a set of evidence-informed guidelines to support young people to talk safely about suicide on social media. It is hoped that they will be a useful resource for young people and those who support them (e.g., parents, teachers, community workers and health professionals).
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ItemResearch Priorities in Suicide Prevention: Review of Australian Research from 2010–2017 Highlights Continued Need for Intervention Research(MDPI AG, 2018)Suicide is a major public health concern in Australia and globally, requiring targeted research efforts to build the evidence base for its effective prevention. We examined current and future priorities in Australian suicide prevention research during the period 2010–2017, and compared these to 1999–2006 baseline data. We classified current research priorities in terms of the type of research published in 424 journal articles and 36 grants and fellowships funded during 2010–2017. A questionnaire administered to 390 stakeholders identified future research priorities. The total number of suicide prevention focussed journal articles and the value of funded grants increased dramatically. Congruent with baseline data, current research priorities in 2010–2017 reflected a strong emphasis on epidemiological studies, while funding for intervention studies declined. This is despite the fact that stakeholders continually identified intervention studies as being the highest future research priority. If we are to make real advances in suicide prevention, we need to know what works, and identify and test effective interventions. This study highlighted the existing dearth and continued need for intervention research. Mechanisms to support future intervention research in suicide prevention are likely to lead to significant gains in knowledge and population health.
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ItemThe effectiveness of suicide prevention delivered by GPs: A systematic review and meta-analysis(ELSEVIER, 2017-03-01)BACKGROUND: The aim of this review was to assess whether suicide prevention provided in the primary health care setting and delivered by GPs results in fewer suicide deaths, episodes of self-harm, attempts and lower frequency of thoughts about suicide. METHODS: We conducted a systematic review and meta-analysis using PRIMSA guidelines. Eligible studies: 1) evaluated an intervention provided by GPs; 2) assessed suicide, self-harm, attempted suicide or suicide ideation as outcomes, and; 3) used a quasi-experimental observational or trial design. Study specific effect sizes were combined using the random effects meta-analysis, with effects transformed into relative risk (RR). RESULTS: We extracted data from 14 studies for quantitative meta-analysis. The RR for suicide death in quasi-experimental observational studies comparing an intervention region against another region acting as a "control" was 1.26 (95% CI 0.58, 2.74). When suicide in the intervention region was compared before and after the GP program, the RR was 0.78 (95% CI 0.62, 0.97). There was no evidence of a treatment effect for GP training on rates of suicide death in one cRCT (RR 1.07, 95% CI 0.79, 1.45). There was no evidence of effect for the most other outcomes studied. LIMITATIONS: All of the studies included in this review are likely to have a high level of bias. It is also possible that we excluded or missed relevant studies in our review process CONCLUSIONS: Interventions have produced equivocal results, which varied by study design and outcome. Given these results, we cannot recommend the roll out of GP suicide prevention initiatives.
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ItemUniversal Suicide Prevention in Young People An Evaluation of the safeTALK Program in Australian High Schools(HOGREFE & HUBER PUBLISHERS, 2017-09)BACKGROUND: Universal education and awareness programs in schools are a promising suicide prevention intervention but to date no research has evaluated the iatrogenic effects of such programs. AIMS: To evaluate the efficacy and acceptability of the safeTALK program for secondary school students and determine whether it is associated with any iatrogenic effects. METHOD: Participants were 129 students from the three main high schools in Alice Springs who attended the safeTALK training and consented to participate in the evaluation. Participants were assessed immediately before and immediately after the training using a purpose-designed survey. Follow-up questionnaires were administered online 4 weeks after completion of the training. RESULTS: Participants demonstrated increases in knowledge about suicide, confidence in talking about issues related to suicide, willingness to talk about suicide, and likelihood of seeking help for suicidal thoughts. There was no evidence that the training induced suicidal thoughts or caused distress; in fact both appeared to decrease following the training. Most participants did not find the training upsetting; they reported the training to be worthwhile and most said that they would recommend it to a friend. LIMITATIONS: The lack of control group, use of non-validated measures, and relatively short follow-up period are limitations of this study. CONCLUSION: Universal suicide prevention workshops in schools can be beneficial and do not appear to be associated with iatrogenic effects.
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ItemSuicide Prevention Media Campaigns: A Systematic Literature Review(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2019-03-21)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.