Melbourne School of Population and Global Health - Research Publications
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ItemSupporting Adolescents Bereaved by Suicide or Other Traumatic Death: The Views of Counselors(SAGE PUBLICATIONS INC, 2024-04-05)Adolescents bereaved by suicide and other traumatic death may experience strong grief reactions and increased risks of mental health problems and suicidal behaviour. As timely access to professional help can be critical, it is essential to understand how counselors perceive suicide bereavement in adolescents and how they work with this population. This study aimed to examine the perspectives of counselors (N = 34). Eleven participated in an individual semi-structured interview and 23 others in group interviews. Thematic analysis yielded three themes: (1) Building a relationship with the bereaved adolescent, (2) Offering support tailored to the needs of the grieving adolescent, and (3) Offering strengths-based and sustainable support. Counselors' skills, attitudes, content-related expertise, and approaching the adolescent's grief within their developmental context were deemed essential for building a therapeutic relationship and offering viable support. The findings may inform good practices in counseling bereaved adolescents to facilitate positive mental health outcomes.
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ItemSuicide prevention during disasters and public health emergencies: a systematic review(Frontiers Media S.A., 2024-02-06)Background: Disasters and public health emergencies increasingly affect populations around the world, posing significant wide-ranging challenges for societies as well as for effective public health and suicide prevention. Intervention research is essential to inform evidence-based responses. Yet, despite evident public concern and growing research interest in heightened suicide risks and impacts, little is known about effective suicide prevention interventions in these contexts. We conducted a systematic review to examine the outcomes of suicide prevention strategies implemented in disasters and public health emergencies. Methods: We searched five databases (Medline, Embase, PsycINFO, Web of Science, PTSDpubs) from inception to December 2022 for peer-reviewed quantitative studies that reported relevant intervention outcomes (changes in the frequency of suicide, suicide attempts, self-harm) for populations affected by disasters and public health emergencies. We assessed the quality of eligible studies using the Quality Assessment Tool for Quantitative Studies, and distilled review findings through narrative synthesis. The study protocol was registered with PROSPERO (CRD42021276195). Results: Ten eligible and mostly observational studies were included in this review, which examined a range of universal, selective, and indicated interventions. Three of five studies of interventions in public health emergencies indicated the potential effectiveness and buffering effects of generic disaster related mental health support, access to urban parks, as well as the beneficial role of video-enabled tablets in facilitating treatment access and outcomes. Similarly, three of five studies of interventions in disaster contexts provided evidence of the beneficial role of universal economic security measures, national gun laws and buy back schemes, and volunteer-delivered mental health support. Overall, four of six studies with favorable outcomes examined interventions specifically deployed in disaster or public health emergency contexts, whereas two studies examined ongoing existing interventions. Three studies, respectively, of suicide prevention focused interventions or generic interventions reported favorable outcomes. The quality of included studies was variable, with two studies being rated as ‘strong’, four studies rated as ‘moderate’, and four studies rated as ‘weak’. Conclusion: Notwithstanding the limited scope and variable quality of published evidence, our review findings highlight the breadth of interventions that have been applied in such contexts with some success. There is a need for further research on effective interventions and intervention adaptations to inform evidence-based suicide prevention responses to disasters and public health emergencies.
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ItemAttributable risk of suicide for populations in Australia(Frontiers Media S.A., 2024)Objective: Each year approximately 3,000 Australians die by suicide. We estimated the population attributable risk for identified target populations to provide evidence on how much of the overall burden of suicide in the Australian population is experienced by each of them. Methods: We identified 17 demographic and clinical target populations at risk of suicide and calculated the population attributable fraction (PAF) using a single or pooled suicide risk and the proportional representation of each target population within Australia. Results: Large PAF estimates were found for men (52%, 95% confidence interval (CI) 51%–53%), people bereaved by suicide (35%, 95% CI 14%–64%), people with a mental health or behavioural condition (33%, 95%CI 17%–48%), people with a chronic physical condition (27%, 95%CI 18%–35%), adults aged 25–64 years (13%, 95%CI 12%–14%), LGB populations (9%, 95%CI 6%–13%), offenders (9%, 95%CI 8%–10%), and people employed in blue collar occupations (8%, 95%CI 4%–12%). Limitations: The PAF is limited by assumptions, namely, that risk factors are independent, and that the relationship between risk factors and outcomes are unidirectional and constant through time. Conclusions and implications for public health: Considerable reductions in the overall suicide rate in Australia may occur if risk factors are addressed in identified populations with large PAF estimates. These estimates should be considered as an adjunct to other important inputs into suicide prevention policy priorities.
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ItemNo Preview AvailableActive involvement of people with lived experience of suicide in suicide research: a Delphi consensus study(BMC, 2023-07-11)BACKGROUND: The importance and value of involvement of people with lived experience of suicide has been recognized in suicide research and prevention. Nonetheless, clear guidance on research collaboration and co-production is lacking. This study aimed to address this gap by developing a set of guidelines on active involvement of people with lived experience of suicide in suicide studies., i.e., conducting research with or by people with lived experience, rather than to, about or for them. METHODS: The Delphi method was used to determine statements on best practice for the active involvement of people with lived experience of suicide in suicide research. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing qualitative data from a recent related study conducted by the authors. Two expert panels: people with lived experience of suicide (n = 44) and suicide researchers (n = 29) rated statements over three rounds of an online survey. Statements endorsed by at least 80% of panellists of each panel were included in the guidelines. RESULTS: Panellists endorsed 96 out of 126 statements in 17 sections covering the full research cycle from deciding on the research question and securing funding, to conducting research and disseminating and implementing outcomes. Overall, there was a substantial level of agreement between the two panels regarding support from research institutions, collaboration and co-production, communication and shared decision making, conducting research, self-care, acknowledgment, and dissemination and implementation. However, panels also disagreed on specific statements regarding representativeness and diversity, managing expectations, time and budgeting, training, and self-disclosure. CONCLUSIONS: This study identified consensus recommendations on active involvement of people with lived experience of suicide in suicide research, including co-production. Support from research institutions and funders, and training on co-production for researchers and people with lived experience, are needed for successful implementation and uptake of the guidelines.
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ItemNo Preview AvailableGrief Instruments in Children and Adolescents: A Systematic Review(SAGE PUBLICATIONS INC, 2023-04-20)Many children and adolescents experience the death of a close person, such as a family member or a friend. However, there is a scarcity of literature on the assessment of grief in bereaved youth. The use of validated instruments is essential to advance our knowledge of grief in children and adolescents. We conducted a systematic review, adhering to PRISMA guidelines, to identify instruments that measure grief in this population and explore their characteristics. Searches in six databases (Medline, PsycINFO, Embase, Emcare, Scopus, and Web of Science) identified 24 instruments, encompassing three categories: general-purpose grief scales, maladaptive grief scales, and specialized grief scales. We extracted data using a predetermined list of descriptive and psychometric properties. Findings indicate a need to direct research towards more stringent validation of existing instruments and the design of new instruments in line with developments in the understanding of grief in this population.
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ItemNo Preview AvailableEvaluating the Effectiveness of Components of National Suicide Prevention Strategies An Interrupted Time Series Analysis(HOGREFE PUBLISHING CORP, 2023-07)Background: National suicide prevention strategies support development of suicide prevention activities and their evaluation. Aims: To describe components included in national suicide prevention strategies and analyze the potential contribution of individual components to reduce suicide rates. Method: We conducted a narrative review and statistical analysis of national suicide prevention strategies. The narrative review was based on a framework of 12 components and included 29 countries (14 lower middle-income countries [LMICs] and 15 high-income countries [HICs]) with a national suicide prevention strategy. The statistical analyses covered suicide mortality data for 24 countries with a national strategy (9 LMICs and 15 HICs). Results: The number of components adopted in national strategies ranged from 4 to 11, and training and education were included in 96.5% of strategies. Estimated period effects for total suicide rates in individual countries ranged from a significant decrease in the yearly suicide rate (RR = 0.80; 95% CI 0.69-0.93) to a significant increase (RR = 1.12; 95% CI 1.05-1.19). There were no changes in suicide mortality associated with individual components of national strategies. Limitations: The limitations of existing suicide mortality data apply to our study. Conclusion: Further detailed evaluations will help identify the specific contribution of individual components to the impact national strategies. Until then, countries should be encouraged to implement and evaluate comprehensive national suicide prevention strategies.
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ItemEnvironmental scan of suicide prevention activity in Australia: Summary Report(Centre for Mental Health, University of Melbourne, 2023-07)The National Suicide Prevention Office provided a grant to the University of Melbourne’s Centre for Mental Health to conduct an environmental scan of the government-led suicide prevention system in Australia to contribute to its workplan, particularly its development of the National Suicide Prevention Strategy. The scan was conducted from August 2022 to January 2023, utilising three key methods: a review of documents, interviews with key informants, and a review of programs and services. Findings demonstrated that Australia’s suicide prevention efforts are significant but that there are many opportunities to further progress suicide prevention and response efforts.
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ItemModelling the cost-effectiveness of brief aftercare interventions following hospital-treated self-harm(Cambridge University Press, 2023-08-01)BACKGROUND: Prior self-harm represents the most significant risk factor for future self-harm or suicide. AIM: To evaluate the cost-effectiveness of a theoretical brief aftercare intervention (involving brief follow-up contact, care coordination and safety planning), following a hospital-treated self-harm episode, for reducing repeated self-harm within the Australian context. METHOD: We employed economic modelling techniques to undertake: (a) a return-on-investment analysis, which compared the cost-savings generated by the intervention with the overall cost of implementing the intervention; and (b) a cost-utility analysis, which compared the net costs of the intervention with health outcomes measured in quality-adjusted life years (QALYs). We considered cost offsets associated with hospital admission for self-harm and the cost of suicide over a period of 10 years in the base case analysis. Uncertainty and one-way sensitivity analyses were also conducted. RESULTS: The brief aftercare intervention resulted in net cost-savings of AUD$7.5 M (95% uncertainty interval: -56.2 M to 15.1 M) and was associated with a gain of 222 (95% uncertainty interval: 45 to 563) QALYs over a 10-year period. The estimated return-on-investment ratio for the intervention's modelled cost in relation to cost-savings was 1.58 (95% uncertainty interval: -0.17 to 5.33). Eighty-seven per cent of uncertainty iterations showed that the intervention could be considered cost-effective, either through cost-savings or with an acceptable cost-effectiveness ratio of 50 000 per QALY gained. The results remained robust across sensitivity analyses. CONCLUSIONS: A theoretical brief aftercare intervention is highly likely to be cost-effective for preventing suicide and self-harm among individuals with a history of self-harm.
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ItemNo Preview AvailableTesting the Impact of the #chatsafe Intervention on Young People's Ability to Communicate Safely About Suicide on Social Media: Protocol for a Randomized Controlled Trial(JMIR PUBLICATIONS, INC, 2023-01)BACKGROUND: Suicide is the leading cause of death among Australians. One commonly cited explanation is the impact of social media, in particular, the ways in which young people use social media to communicate about their own experiences and their exposure to suicide-related content posted by others. Guidelines designed to assist mainstream media to safely report about suicide are widespread. Until recently, no guidelines existed that targeted social media or young people. In response, we developed the #chatsafe guidelines and a supporting social media campaign, which together make up the #chatsafe intervention. The intervention was tested in a pilot study with positive results. However, the study was limited by the lack of a control group. OBJECTIVE: The aim of this study is to assess the impact of the #chatsafe social media intervention on young people's safety and confidence when communicating on the web about suicide. METHODS: The study employs a pragmatic, parallel, superiority randomized controlled design. It will be conducted in accordance with the Consolidated Standards of Reporting Trials statement over 18 months. Participants will be 400 young people aged 16-25 years (200 per arm). Participants will be recruited via social media advertising and assessed at 3 time points: time 1-baseline; time 2-8-week postintervention commencement; and time 3-4-week postintervention. They will be asked to complete a weekly survey to monitor safety and evaluate each piece of social media content. The intervention comprises an 8-week social media campaign including social media posts shared on public Instagram profiles. The intervention group will receive the #chatsafe suicide prevention content and the control group will receive sexual health content. Both groups will receive 24 pieces of content delivered to their mobile phones via text message. The primary outcome is safety when communicating on the web about suicide, as measured via the purpose-designed #chatsafe online safety questionnaire. Additional outcomes include willingness to intervene against suicide, internet self-efficacy, safety, and acceptability. RESULTS: The study was funded in November 2020, approved by the University of Melbourne Human Research Ethics Committee on October 7, 2022, and prospectively registered with the Australian New Zealand Clinical Trials registry. Trial recruitment began in November 2022 and study completion is anticipated by June 2024. CONCLUSIONS: This will be the first randomized controlled trial internationally to test the impact of a social media intervention designed to equip young people to communicate safely on the web about suicide. Given the rising rates of youth suicide in Australia and the acceptability of social media among young people, incorporating social media-based interventions into the suicide prevention landscape is an obvious next step. This intervention, if effective, could also be extended internationally, thereby improving web-based safety for young people not just in Australia but globally. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12622001397707; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384318. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44300.
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ItemNo Preview AvailableEvaluation of a New Online Program for Children Bereaved by Suicide: The Views of Children, Parents, and Facilitators(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2024-01-02)OBJECTIVE: Experiencing the suicide of a parent or a sibling is one of the most disruptive and stressful events in the life of a child or adolescent. Yet, little is known about the effectiveness of support offered to children and adolescents bereaved by suicide. This study aimed to evaluate participant and facilitator's perceived helpfulness of the new online Let's Talk Suicide program, piloted in 2021. METHOD: Thematic Analysis of qualitative interviews with 4 children, 7 parents, and 3 facilitators (N = 14). RESULTS: The analysis identified four themes focused on suicide bereavement specific support, the online environment experiences, expectations and perceived outcomes of the program, and parents' involvement in the program. CONCLUSIONS: The young participants, parents, and facilitators were very positive about the program. They felt that it supported the children in their grief after suicide, helped to normalize their experiences, offered social support from peers and professionals, and enhanced their language and skills to express themselves and to deal with their emotions. Though longitudinal research is needed, the new program seems to address an existing gap in postvention services for children and adolescents bereaved by suicide. HIGHLIGHTSThe children felt supported in their grief as it enhanced their skills and language to express themselves.The program also acknowledged the parents and supported them in their parenting role.Future longitudinal studies may enhance the evidence of effectiveness of the program.