Information needs of people after a suicide attempt: A thematic analysis

The experiences of living with a suicidal family member, and the impact on daily life: A systematic review and meta-aggregation

INTRODUCTION

Because of the pivotal role that family members play in caring for their suicidal relative, insight into their experiences is necessary to develop good support for them.

AIM

This systematic review aimed to aggregate qualitative research examining the experiences of family members living with their suicidal relative, and their impact on daily life.

METHODS

Systematic searches, covering the period 2000-2022, were conducted in Medline, Embase, PsycINFO, Ovid Nursing database and CINAHL. The JBI-QARI meta-aggregation approach and the PRISMA guidelines were followed.

RESULTS

Eleven studies met the inclusion criteria. Six themes were identified: The hard job of managing the risk of suicide; contributing to the relative's survival; struggling with professional care; being in a lonely position; pressure on relationships; and disruption of well-being.

DISCUSSION

The constant worry of losing their relative and ever-present vigilance dominates their lives in such a way that their well-being may be decreased. Professionals often overlook family members, which leads to feelings of powerlessness and loneliness.

IMPLICATIONS FOR PRACTICE

Collaborating with families in treatment, allowing them to share information and supporting them in the care at home may lead to better outcomes for both the family and their suicidal relative.

Evaluation of an online suicide prevention program to improve suicide literacy and to reduce suicide stigma: A mixed methods study

Low-threshold e-health approaches in prevention to reduce suicide stigma are scarce. We developed an online program containing video reports on lived experience of suicide and evidence-based information on suicidality. We evaluated the program by a mixed methods design. We examined pre-post-changes of program completers (n = 268) in suicide literacy, suicide stigma (self and perceived), and self-efficacy expectation of being able to seek support in psychologically difficult situations using linear mixed models. To examine reported changes and helpful program elements 12-26 weeks after program completion, we content analyzed transcripts of telephone interviews (n = 16). Program completers showed more suicide literacy (Cohen's d = .74; p < .001), higher self-efficacy expectations to seek support (d = .09; p < .01), lower self-stigma (subscales glorification/normalization: d = -.13, p = .04; isolation/depression: d = -.14; p = .04; stigma: d = -.10; p = .07; n = 168) compared to baseline. We found no significant differences in perceived suicide stigma. We identified lived experience reports, the possibility of sharing own narrative on stigma and suicidality, and information on support as helpful elements. The current online program can increase suicide literacy and self-efficacy expectations to seek support and reduce self-stigma. We recommend a larger randomized controlled trial with longer follow-up to confirm these findings.

Psychological well-being in US veterans with non-fatal suicide attempts: A multi-cohort population-based study

BACKGROUND

Most people who survive suicide attempts neither re-attempt suicide nor die by suicide. Research on suicide attempt survivors has primarily focused on negative endpoints (e.g., increased suicide risk) rather than positive outcomes. One important outcome is psychological well-being (PWB), defined as positive functioning across emotional, intrapersonal, and interpersonal domains. We compared PWB among US military veterans with (i.e., attempt survivors) and without (i.e., non-attempters) a history of suicide attempt(s) using data from three nationally representative cohorts.

METHODS

Each US veteran cohort (Cohort1: N = 3148; Cohort2: N = 1474; Cohort3: N = 4042) completed measures of suicidality (e.g., attempt history), character strengths (e.g., curiosity, optimism), psychological symptoms (e.g., depression), and indicators of PWB (e.g., happiness). t-Tests were conducted to examine group differences in PWB; hierarchical regressions were conducted to examine suicide attempt status as a predictor of PWB controlling for symptoms and demographics. Multivariable regressions were conducted to identify predictors of PWB among attempt survivors.

RESULTS

In each cohort, reported PWB was markedly lower among suicide attempt survivors than non-attempters (ds = 0.9-1.2), even after adjusting for mental health symptoms. Individual differences in PWB were observed, with a subset of suicide attempt survivors reporting higher PWB levels than non-attempters (1.4-7.4 %). Curiosity and optimism were positively associated with PWB among suicide attempt survivors (rs = 0.60-0.78).

LIMITATIONS

Data were cross-sectional, limiting inferences about causation and directionality of associations.

CONCLUSIONS

Findings highlight diminished PWB as an important and understudied concern among veteran attempt survivors. Collectively, our findings underscore the importance of considering PWB in the research, assessment, and treatment of suicidality.

A Systematic Review of the Experiences and Support Needs of Informal Caregivers for People Who Have Attempted Suicide or Experienced Suicidal Ideation

Informal caregivers include family, friends, and significant others who provide important support for people who have attempted suicide or experienced suicidal ideation. Despite the prevalence of suicidal behaviour worldwide, they remain an understudied population. This review aimed to synthesise the literature on the experiences and support needs of informal caregivers of people who have attempted suicide or experienced suicidal ideation. We conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, Emcare, Embase, EBM Reviews, and PsycINFO identified 21 studies (4 quantitative and 17 qualitative), published between 1986 and 2021. Informal carers commonly reported symptoms of depression and anxiety, for which they receive little assistance. They also expressed a desire for more involvement and education in the professional care of suicidality. Together, the studies indicated a need to improve the way informal caregiving is managed in professional healthcare settings. This review identified potential avenues for future research, as well as broad areas which require attention in seeking to improve the care of suicidal people and their caregivers.

Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study

This study explored the experiences of healthcare consumers who had recently attempted suicide, and their carers, following placement on a Suicide Prevention Pathway based on the Zero Suicide framework. Qualitative interviews were conducted with 10 consumers and 5 carers using a semi-structured interview schedule. Interviews were transcribed and thematic analysis was applied to identify prominent themes and sub-themes. Three interrelated themes were identified. The first theme was 'Feeling safe and valued' with the associated sub-theme pertaining to perceived stigmatizing treatment and self-stigma. The second was 'Intersection of consumer and staff/organizational needs' with a related sub-theme of time pressure and reduced self-disclosure. The final theme was 'Importance of the 'whole picture', highlighting the relevance of assessing and addressing psychosocial factors when planning for consumer recovery. Overall, consumers and their carers reported a favorable experience of the Suicide Prevention Pathway; however, there were several areas identified for improvement. These included reconciling the time-pressures of a busy health service system, ensuring consumers and carers feel their psychosocial concerns are addressed, and ensuring that adequate rapport is developed. Key to this is ensuring consumers feel cared for and reducing perceptions of stigma.

Not discussed: Inequalities in narrative text data for suicide deaths in the National Violent Death Reporting System

Background

The rate of suicide in the US has increased substantially in the past two decades, and new insights are needed to support prevention efforts. The National Violent Death Reporting System (NVDRS), the nation’s most comprehensive registry of suicide mortality, has qualitative text narratives that describe salient circumstances of these deaths. These texts have great potential for providing novel insights about suicide risk but may be subject to information bias.

Objective

To examine the relationship between decedent characteristics and the presence and length of NVDRS text narratives (separately for coroner/medical examiner (C/ME) and law enforcement (LE) reports) among 233,108 suicide and undetermined deaths from 2003–2017.

Methods

Generalized estimating equations (GEE) logistic and quasi-Poisson modeling was used to examine variation in the narratives (proportion of missing texts and character length of the non-missing texts, respectively) as a function of decedent age, sex, race/ethnicity, education, marital status, military history, and homeless status. Models adjusted for site, year, location of death, and autopsy status.

Results

The frequency of missing narratives was higher for LE vs. C/ME texts (19.8% vs. 5.2%). Decedent characteristics were not consistently associated with missing text across the two types of narratives (i.e., Black decedents were more likely to be missing the LE narrative but less likely to be missing the C/ME narrative relative to non-Hispanic whites). Conditional on having a narrative, C/ME were significantly longer than LE (822.44 vs. 780.68 characters). Decedents who were older, male, had less education and some racial/ethnic minority groups had shorter narratives (both C/ME and LE) than younger, female, more educated, and non-Hispanic white decedents.

Conclusion

Decedent characteristics are significantly related to the presence and length of narrative texts for suicide and undetermined deaths in the NVDRS. Findings can inform future research using these data to identify novel determinants of suicide mortality.

The Presence and the Search Constructs of Meaning in Life in Suicidal Patients Attending a Psychiatric Emergency Department

Meaning in Life (MiL) is considered protective against suicidal behavior (SB). However, few studies specifically addressed the role of the constructs, "presence of MiL" and "search for MiL," and their dynamic interplay. In this cross-sectional study of patients with SB (N = 199) visiting a psychiatric Emergency Department for either suicidal ideation (SI) or suicide attempt (SA), we pursued the following objectives: 1) to explore the relationship between the two constructs; 2) to verify the protective value of presence of MiL on SB; and 3) to assess the influence of search for MiL on the relationship between presence of MiL and SI. The two constructs were found to be independent of one another. Higher presence of MiL was globally associated with lower SB levels, particularly SI. Search for MiL was not related to SB and did not moderate the relationship between presence of MiL and SI. In conclusion, formal support for the role of presence of MiL against SB in a psychiatric sample was demonstrated. These findings, with a view toward refinement of SB risk assessment and new psychotherapeutic approaches, may lead to an enrichment of the dialogue with suicidal patients to help alleviate their unbearable suffering. Our conclusions must be replicated in psychiatric clinical populations in settings other than a psychiatric ED and by using a longitudinal prospective and case-control study design.