Psychiatry - Research Publications
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ItemNo Preview AvailableAcceptability and Potential Impact of the #chatsafe Suicide Postvention Response Among Young People Who Have Been Exposed to Suicide: Pilot Study(JMIR PUBLICATIONS, INC, 2023)BACKGROUND: Young people are more likely to be affected by suicide contagion, and there are concerns about the role social media plays in the development and maintenance of suicide clusters or in facilitating imitative suicidal behavior. However, social media also presents an opportunity to provide real-time and age-appropriate suicide prevention information, which could be an important component of suicide postvention activities. OBJECTIVE: This study aimed to test an intervention designed to equip young people to communicate safely online about suicide (#chatsafe) with a sample of young people who had recently been exposed to a suicide or suicide attempt, with a view to determining the role social media can play as part of a postvention response. METHODS: A sample of 266 young people from Australia, aged 16 to 25 years, were recruited to participate in the study. They were eligible if they had been exposed to a suicide or knew of a suicide attempt in the past 2 years. All participants received the #chatsafe intervention, which comprised 6 pieces of social media content that were sent to them weekly via direct message through Instagram, Facebook, or Snapchat. Participants were assessed on a range of outcome measures (social media use, willingness to intervene against suicide, internet self-efficacy, confidence, and safety when communicating about suicide on social media platforms) at baseline, immediately after the intervention, and at 4-week follow-up. RESULTS: After the 6-week #chatsafe intervention, participants reported substantial improvements in their willingness to intervene against suicide online, their internet self-efficacy, and their perceived confidence and safety when communicating about suicide online. Overall, the participants reported that it was appropriate to receive the #chatsafe intervention via social media, and no iatrogenic effects were recorded. CONCLUSIONS: The findings suggest that it is safe and acceptable to disseminate suicide prevention information entirely via social media among young people who have recently been exposed to a suicide or suicide attempt. Interventions such as #chatsafe could potentially mitigate the risk of distress and future suicidal behavior in young people by improving the quality and safety of online communication about suicide and, as such, can be an important component of delivering a postvention response to young people.
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ItemCost-effectiveness of media reporting guidelines for the prevention of suicide(WILEY, 2022-10)INTRODUCTION: Media guidelines for the responsible reporting of suicide are a recognized universal suicide prevention intervention. While implemented in numerous countries, including Australia, little is known about whether they are cost-effective. We aimed to determine the cost-effectiveness of Mindframe, the national initiative implementing media guidelines in Australia. METHOD: We conducted a modelled economic evaluation (5-year time-horizon) incorporating two types of economic analysis: (i) return-on-investment (ROI) comparing estimated cost savings from the intervention to the total intervention cost, and (ii) cost-effectiveness analysis comparing the net intervention costs to health outcomes: suicide deaths prevented and quality-adjusted life-years (QALYs). We also included uncertainty analyses to propagate parameter uncertainty and sensitivity analyses to test the robustness of the model outputs to changes in input parameters and assumptions. RESULTS: The estimated ROI ratio for the main analysis was 94:1 (95% uncertainty interval [UI]: 37 to 170). The intervention was associated with cost savings of A$596M (95% UI: A$228M to A$1,081M), 139 (95% UI: 55 to 252) suicides prevented and 107 (95% UI: 42 to 192) QALYs gained. The intervention was dominant, or cost-saving, compared with no intervention with results being robust to sensitivity analysis but varying based on the conservativeness of the parameters entered. CONCLUSION: Mindframe was found to be cost-saving, and therefore, worthy of investment and inclusion as part of national suicide prevention strategies.
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ItemNo Preview AvailableOutcomes of Victorian Prevention and Recovery Care Services: A matched pairs comparison(SAGE PUBLICATIONS LTD, 2021-12)OBJECTIVE: In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. METHODS: We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care ('PARCS consumers') with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period ('inpatient-only consumers'). We used routinely collected data to compare them on a range of outcomes. RESULTS: Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. CONCLUSION: Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.
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ItemInfluencing the Conversation About Masculinity and Suicide: Evaluation of the Man Up Multimedia Campaign Using Twitter Data(JMIR Publications, 2017-10-09)Background: It has been suggested that some dominant aspects of traditional masculinity are contributing to the high suicide rates among Australian men. We developed a three-episode documentary called Man Up, which explores the complex relationship between masculinity and suicide and encourages men to question socially imposed rules about what it means to be a man and asks them to open up, express difficult emotions, and seek help if and when needed. We ran a three-phase social media campaign alongside the documentary using 5 channels (Twitter, Facebook, Instagram, YouTube, and Tumblr). Objective: This study aimed to examine the extent to which the Man Up Twitter campaign influenced the social media conversation about masculinity and suicide. Methods: We used Twitter insights data to assess the reach of and engagement with the campaign (using metrics on followers, likes, retweets, and impressions) and to determine the highest and lowest performing tweets in the campaign (using an aggregated performance measure of reactions). We used original content tweets to determine whether the campaign increased the volume of relevant Twitter conversations (aggregating the number of tweets for selected campaign hashtags over time), and we used a subset of these data to gain insight into the main content themes with respect to audience engagement. Results: The campaign generated a strong following that was engaged with the content of the campaign; over its whole duration, the campaign earned approximately 5000 likes and 2500 retweets and gained around 1,022,000 impressions. The highest performing tweets posted by the host included video footage and occurred during the most active period of the campaign (around the screening of the documentary). The volume of conversations in relation to commonly used hashtags (#MANUP, #ABCMANUP, #LISTENUP, and #SPEAKUP) grew in direct relation to the campaign activities, achieving strongest growth during the 3 weeks when the documentary was aired. Strongest engagement was found with content related to help-seeking, masculinity, and expressing emotions. A number of followers tweeted personal stories that revealed overwhelmingly positive perceptions of the content of the documentary and strongly endorsed its messages. Conclusions: The Man Up Twitter campaign triggered conversations about masculinity and suicide that otherwise may not have happened. For some, this may have been game-changing in terms of shifting attitudes toward expressing emotions and reaching out to others for help. The campaign was particularly effective in disseminating information and promoting conversations in real time, an advantage that it had over more traditional health promotion campaigns. This sort of approach could well be adapted to other areas of mental (and physical) health promotion campaigns to increase their reach and effectiveness.
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ItemAssociation of suicidal behavior with exposure to suicide and suicide attempt: A systematic review and multilevel meta-analysis(PUBLIC LIBRARY SCIENCE, 2020-03)BACKGROUND: Exposure to suicidal behavior may be associated with increased risk of suicide, suicide attempt, and suicidal ideation and is a significant public health problem. However, evidence to date has not reliably distinguished between exposure to suicide versus suicide attempt, nor whether the risk differs across suicide-related outcomes, which have markedly different public health implications. Our aim therefore was to quantitatively assess the independent risk associated with exposure to suicide and suicide attempt on suicide, suicide attempt, and suicidal ideation outcomes and to identify moderators of this risk using multilevel meta-analysis. METHODS AND FINDINGS: We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, ASSIA, Sociological Abstracts, IBSS, and Social Services Abstracts from inception to 19 November 2019. Eligible studies included comparative data on prior exposure to suicide, suicide attempt, or suicidal behavior (composite measure-suicide or suicide attempt) and the outcomes of suicide, suicide attempt, and suicidal ideation in relatives, friends, and acquaintances. Dichotomous events or odds ratios (ORs) of suicide, suicide attempt, and suicidal ideation were analyzed using multilevel meta-analyses to accommodate the non-independence of effect sizes. We assessed study quality using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies. Thirty-four independent studies that presented 71 effect sizes (exposure to suicide: k = 42, from 22 independent studies; exposure to suicide attempt: k = 19, from 13 independent studies; exposure to suicidal behavior (composite): k = 10, from 5 independent studies) encompassing 13,923,029 individuals were eligible. Exposure to suicide was associated with increased odds of suicide (11 studies, N = 13,464,582; OR = 3.23, 95% CI = 2.32 to 4.51, P < 0.001) and suicide attempt (10 studies, N = 121,836; OR = 2.91, 95% CI = 2.01 to 4.23, P < 0.001). However, no evidence of an association was observed for suicidal ideation outcomes (2 studies, N = 43,354; OR = 1.85, 95% CI = 0.97 to 3.51, P = 0.06). Exposure to suicide attempt was associated with increased odds of suicide attempt (10 studies, N = 341,793; OR = 3.53, 95% CI = 2.63 to 4.73, P < 0.001), but not suicide death (3 studies, N = 723; OR = 1.64, 95% CI = 0.90 to 2.98, P = 0.11). By contrast, exposure to suicidal behavior (composite) was associated with increased odds of suicide (4 studies, N = 1,479; OR = 3.83, 95% CI = 2.38 to 6.17, P < 0.001) but not suicide attempt (1 study, N = 666; OR = 1.10, 95% CI = 0.69 to 1.76, P = 0.90), a finding that was inconsistent with the separate analyses of exposure to suicide and suicide attempt. Key limitations of this study include fair study quality and the possibility of unmeasured confounders influencing the findings. The review has been prospectively registered with PROSPERO (CRD42018104629). CONCLUSIONS: The findings of this systematic review and meta-analysis indicate that prior exposure to suicide and prior exposure to suicide attempt in the general population are associated with increased odds of subsequent suicidal behavior, but these exposures do not incur uniform risk across the full range of suicide-related outcomes. Therefore, future studies should refrain from combining these exposures into single composite measures of exposure to suicidal behavior. Finally, future studies should consider designing interventions that target suicide-related outcomes in those exposed to suicide and that include efforts to mitigate the adverse effects of exposure to suicide attempt on subsequent suicide attempt outcomes.
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ItemThe impact of substance use on treatment as a compulsory patient(SAGE PUBLICATIONS LTD, 2019-08)OBJECTIVES: This paper considers the impact of having a diagnosis of substance use disorder on the utilisation of compulsory orders under the Victorian Mental Health Act (2014). METHODS: We analysed the subsequent treatment episodes over 2 years of people who had been on a community treatment order for at least 3 months and determined the odds of a further treatment order if there was a diagnosis of substance use at or about the time the index community treatment order ended. RESULTS: An additional diagnosis of a substance use disorder was coded in 47.7% and was associated with significantly increased odds of a subsequent treatment order in the following 2 years for those with a main diagnosis of schizophrenia (AOR = 3.03, p<0.001) and 'other' disorders (AOR = 11.60, p=0.002). Those with a main diagnosis of mood disorder had a significant increase in odds for an inpatient treatment order if there was an additional substance use disorder diagnosis (AOR = 3.81, p=0.006). CONCLUSIONS: Having an additional diagnosis of substance use disorder was associated with increased likelihood of being placed on an order. This study supports greater emphasis being given to treatment of substance use concurrently with that of mental illness.
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ItemDoes legislative change affect the use and duration of compulsory treatment orders?(SAGE PUBLICATIONS LTD, 2019-05)OBJECTIVE: Victoria, Australia, introduced reformed mental health legislation in 2014. The Act was based on a policy platform of recovery-oriented services, supported decision-making and minimisation of the use and duration of compulsory orders. This paper compares service utilisation and legal status after being on a community treatment order under the Mental Health Act 1986 (Vic) with that under the Mental Health Act 2014 (Vic). METHODS: We obtained two distinct data sets of persons who had been on a community treatment order for at least 3 months and their subsequent treatment episodes over 2 years under the Mental Health Act and/or as an inpatient for the periods 2008-2010 (Mental Health Act 1986) and 2014-2016 (Mental Health Act 2014). The two sets were compared to assess the difference in use, duration and odds of having a further admission over 2 years. We also considered the mode of discharge - whether by the treating psychiatrist, external body or through expiry. RESULTS: Compared with the Mental Health Act 1986, under the Mental Health Act 2014, index community treatment orders were shorter (mean 227 days compared with 335 days); there was a reduction in the mean number of community treatment orders in the 2 years following the index discharge - 1.1 compared with 1.5 (incidence rate ratio (IRR) = 0.71, 95% confidence interval = [0.63, 0.80]) - and a 51% reduction in days on an order over 2 years. There was a reduction in the number of subsequent orders for those whose order expired or was revoked by the psychiatrist under the Mental Health Act 2014 compared to those under the Mental Health Act 1986. The number of orders which were varied to an inpatient order by the authorised psychiatrist was notably greater under the Mental Health Act 2014. CONCLUSION: The reformed Mental Health Act has been successful in its intent to reduce the use and duration of compulsory orders in the community. The apparent increase in return to inpatient orders raises questions regarding the intensity and effectiveness of community treatment and context of service delivery.
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ItemEvaluating the effectiveness of a website about masculinity and suicide to prompt help-seeking.(Wiley - John Wiley & Sons, 2019-02-25)ISSUE ADDRESSED: A website was designed to form the core of a multimedia strategy surrounding the Man Up documentary - a three-part documentary that aimed to address the problem of male suicide in Australia. Together these formed a media-based, public health intervention that explored the link between masculinity and suicide and promoted help-seeking. This is of great importance given the demonstrated link between masculine norms, men's reduced help-seeking and suicidal thinking. This study assesses the website's effectiveness in facilitating help-seeking and fostering conversations about suicide, mental health and help-seeking. Help-seeking indicators included website clicks to helping organisations, downloads of health information from the website and request for help received via emails. METHODS: Google Analytics data, emails to the Man Up team received through the website and open-ended responses to an online survey were analysed. RESULTS: The website reached 43 140 users. Indictors of help-seeking activity on the website included 307 outbound clicks to helping organisations and 802 downloads of health information. Qualitative analysis of emails received and responses to the survey demonstrated that Man Up's messages resonated with viewers and provided further evidence of help-seeking. CONCLUSION: The findings demonstrate that the website provided an important opportunity for people to engage with Man Up and seek help. SO WHAT?: Media-based public health interventions offer enormous potential to provide suicide prevention interventions and promote help-seeking. The website evaluation findings provide insight into the ways in which websites can be used as part of a multimedia strategy to address the problem of male suicide.
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ItemUsing Social Media Networks to Engage Men in Conversations on Masculinity and Suicide: Content Analysis of Man Up Facebook Campaign Data(SAGE Publications (UK and US), 2019-10-01)We analyzed comments published on the Man Up Facebook page (manuptvseries) during the roll-out of the Man Up digital campaign. The aim was to gain insight into how the public perceived the Man Up campaign and the conversation topics that the campaign instigated. We downloaded Facebook threads (posts and comments) from the manuptvseries page using NCapture and performed conventional content analysis on a random set of comments (n = 2,236) to identify how the campaign was perceived and what were the popular conversations. Overall, the campaign was perceived extremely positively by the Facebook audience showing many comments endorsing the content of the campaign by sharing among their Facebook community. The strongest themes were expressing emotions, help and support, and masculinity/gender roles which related to the higher level theme of expressions of masculinity. Another strong theme was suicide and topics related to suicide. Comments acknowledged the importance of discussing the issues of male suicide and masculinity publicly. Men were less engaged with topics on masculinity and expressing emotions compared with women and recognized stigma around help-seeking for mental health issues. The Man Up Facebook campaign did foster a public discussion on masculinity and suicide. A gendered approach in mental health promotion is needed with stigma still present for men when seeking help for mental health problems. Social media holds considerable potential for the use of health promotion campaigns aiming to increase interpersonal communication on challenging health topics. Yet, these campaigns need to carefully manage the risk of reinforcing stereotypes.
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ItemNo Preview AvailableEngaging Australian men in masculinity and suicide - A concept test of social media materials and a website(WILEY, 2019-09)ISSUE ADDRESSED: Men dominate the suicide statistics and are less likely than women to seek help for emotional problems, and this has been linked to aspects of stoic masculinity. Promoting help-seeking and challenging stoic thinking may help to address this problem, but it is unclear what works in engaging men in these topics. METHODS: We developed a multimedia intervention called Man Up - including a documentary and digital campaign. We tested promotional materials and the website by interviewing 17 men from different ages and backgrounds about their perceptions, and asked them whether the materials generated interest in the topics of the documentary. RESULTS: Participants preferred visual materials that were relatable to them and included active and direct language. This helped them to understand and identify with the messages being imparted. Participants had mixed views on talking about masculinity and the use of the term "man up," with some expressing interest and others being deterred by it. Sharing content about mental health and suicide was seen by some as a risk to personal reputation and their relationships with others. CONCLUSIONS: Our findings informed the design of targeted materials for the national Man Up campaign and website which were then used in a multilevel national health promotion intervention in Australia. SO WHAT?: Our study provided valuable insights beyond Man Up for those seeking to design and deliver health promotion interventions targeting Australian men and engage in sensitive and stigmatised male health issues. Using active and empowering language was especially important when addressing men which contrasts with many promotional materials currently available.