Developing an Intervention for Suicide Prevention: A Rapid Review of Lived Experience Involvement

Comparative insights into suicide prevention: a cross-sectional analysis of English local authority audit reports and action plans

BACKGROUND

Suicide rates in the UK are rising, highlighting the need for effective local interventions. This study examined whether English local authorities (LAs) have conducted suicide audits, key findings and whether these were used to develop their action plans.

METHODS

This cross-sectional study assessed suicide audits and action plans from 153 LAs, using data collected from Freedom of Information requests, using statistical (Chi-square test) and thematic analysis.

RESULTS

Of 153 LAs, 8 did not respond. Of the remaining 145 LAs, 60% conducted audits. Data from 88 suicide audits and 113 action plans were analysed. Males between 45 and 64 years old were found to have the highest incidence of suicide; coastal LAs reported significantly higher suicide rates than the national average (P = .009). Locations (60.2%) and methods of suicide (62.5%) were recognized as key factors for intervention.

CONCLUSIONS

The aim and scope of suicide audits and action plans vary significantly. Identified risk factors were higher in coastal LAs, and support for men remains inadequate. Standardized guidelines could improve the impact and consistency of data collection and assist in the development of robust strategies to tackle suicide prevention initiatives.

Lived Experience Participation in Suicide Prevention Activities in Australia, a Scoping Review

INTRODUCTION

Lived experience inclusion is considered best practice in suicide prevention activities. Despite this, research remains limited exploring how individuals with lived experience actively engage in suicide research and prevention activities. The current scoping review aimed to map and summarise the existing literature describing the 'how' of lived experience participation in Australia.

METHODS

A scoping review according to the methodology of Arksey and O'Malley (2005) was undertaken with descriptive (e.g., study aims and methodology) and descriptive analytic data (such as key definitions and participation descriptors) being extracted from included studies.

RESULTS

A total of 42 studies met the inclusion criteria and were published between 2016 and 2023. There were many gaps in the data extracted, with participation descriptors and definitions often not reported in the literature. The included studies lacked clear and consistent definitions and practices when involving people with lived experience.

CONCLUSION

Current processes for reporting experiences of lived experience participation in suicide prevention lack standardisation within peer-reviewed publications. This review notes that there are gaps in the literature; however, the evidence base is growing for research that reports on suicide prevention research and activities that involve people with lived experience.

PATIENT OR PUBLIC CONTRIBUTION

This study was created and undertaken by a PhD candidate with lived experience of thoughts of suicide, suicide attempt and caring for a loved one through suicide. A further team member has lived experience of being a suicide attempt survivor, continued thoughts of suicide and carer of family with suicidal thoughts. The study was informed by a Community Advisory Committee, of which four members have lived experience of suicide, with the remaining two having lived experience in areas where inclusion is paramount such as disability and suicide research. Ethics approval was not required for the participation of the Community Advisory Committee as they were providing advice only on the research conduct.

'Wisdom Is Knowledge Plus Experience': Qualitative Study of Lived Experience and Researcher Perspectives on Suicide Research Co-Production

The need for involvement of people with lived experience of suicide in the conduct of suicide research and intervention has been recognised in research and policy. However, there is limited understanding and guidance on how to support their genuine and safe engagement in suicide research. This qualitative study considered the perspectives of 19 people with lived experience of suicide, and 17 researchers engaged in suicide-related research to explore their needs, expectations and experience of co-produced suicide-related research. Data was collected between October and December 2020 via semi-structured interviews. Thematic analysis resulted in five themes: (1) towards co-production, (2) power imbalances, (3) heterogeneity of lived experience, (4) enhancing safety and (5) value of co-production. Participants considered lived experience involvement at all stages of research to improve research impact and outcomes. However, persisting power imbalances were experienced by participants and participatory approaches did not always align with existing research systems and organisational structures. Complexities identified by participants related to accommodating different skills, experiences and social identities of those with a lived experience perspective and balancing safeguarding principles with strength-based approaches that may capitalise on participants' existing strengths. Delphi guidelines developed from an associated consensus study on active involvement of people with lived experience of suicide in suicide research address some of the concerns mentioned by study participants and form a useful resource to guide future research endeavours.

Towards development of guidelines for harnessing implementation science for suicide prevention: an international Delphi expert consensus study

Objectives

Suicide research and prevention are complex. Many practical, methodological and ethical challenges must be overcome to implement effective suicide prevention interventions. Implementation science can offer insights into what works, why and in what context. Yet, there are limited real-world examples of the application of implementation science in suicide prevention. This study aimed to identify approaches to employ principles of implementation science to tackle important challenges in suicide prevention.

Methods

A questionnaire about promoting implementation science for suicide prevention was developed through thematic analysis of stakeholder narratives. Statements were categorised into six domains: research priorities, practical considerations, approach to intervention design and delivery, lived experience engagement, dissemination and the way forward. The questionnaire (n=52 statements-round 1; n=44 statements-round 2; n=9 statements-round 3) was administered electronically to a panel (n=62-round 1, n=48-round 2; n=45-round 3) of international experts (suicide researchers, leaders, project team members, lived experience advocates). Statements were rated on a Likert scale based on an understanding of importance and priority of each item. Statements endorsed by at least 85% of the panel would be included in the final guidelines.

Results

Eighty-two of the 90 statements were endorsed. Recommendations included broadening research inquiries to understand overall programme impact; accounting for resources in the translation of evidence into practice; embedding implementation science in intervention delivery and design; meaningfully engaging lived experience; considering channels for dissemination of implementation-related findings and focusing on next steps needed to routinely harness the strengths of implementation science in suicide prevention research, practice and training.

Conclusion

An interdisciplinary panel of suicide prevention experts reached a consensus on optimal strategies for using implementation science to enhance the effectiveness of policies and programmes aimed at reducing suicide.

The experiences of consumers, clinicians and support persons involved in the safety planning intervention for suicide prevention: a qualitative systematic review and meta-synthesis

Background

The Safety Planning Intervention (SPI) is an efficacious brief intervention for supporting people experiencing suicidal ideation and behavior. However, the subjective experiences of those who have used the SPI have not been systematically evaluated. This systematic review synthesized qualitative evidence regarding the experiences of people involved in the SPI.

Method

Systematic searches of international, peer-reviewed, English language literature were conducted in seven databases (CINAHL, Embase, Emcare, MEDLINE, PsycInfo, Scopus and Web of Science).

Results

A total of 588 articles were screened for eligibility, with screening, data extraction, and critical appraisal conducted in duplicate. Qualitative data were extracted from 10 included studies and synthesized via meta-aggregation. Ninety individual findings were aggregated into 14 unique categories, with categories subsequently combined to produce four synthesized findings: acceptability and positive outcomes associated with the SPI; maximizing the effectiveness of the SPI; navigating the involvement of support persons in the SPI process; barriers and limitations associated with the SPI.

Discussion

Collectively, findings indicate that the SPI is viewed as beneficial by users and can be enhanced through clinicians' use of a person-centered, collaborative approach, as well as through the inclusion of support persons. Future research should seek lived experience understandings from more diverse stakeholders, particularly regarding consumers' experiences of using the SPI during acute distress. Further research is required to investigate causal pathways between SPI engagement and improved outcomes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022312425, identifier CRD42022312425.

Involving Young People With Lived and Living Experience of Suicide in Suicide Research

Background: Research into youth suicide prevention rarely involves young people with lived and living experiences as collaborators. Key barriers include a lack of guidelines or frameworks to inform collaboration, appropriate ethical approval processes, perceived risk, and recruitment. Aim: To develop guidelines for involving young people with lived and living experiences in suicide research as collaborators. Method: A Delphi expert consensus study was conducted with two expert panels: a youth lived and living experiences panel and a traditionally qualified researcher panel. Items rated as essential or important using a five-point Likert scale by more than 80% of both panels were included in the guidelines. Results: Forty-nine experts completed two consensus rounds. The guidelines are organized as follows: (1) preparation, (2) supporting safety and well-being, (3) evaluating involvement, and (4) tips for young people. Limitations: Participants were from English-speaking, Western countries only. Conclusion: These world-first guidelines address the unique challenges and opportunities for involving young people with lived and living experiences in suicide research.

Understanding the needs and perspectives of young adults with recent suicidal ideation: insights for suicide prevention

Introduction

Suicide rates among adolescents and young people are increasing, especially in Western countries. Suicidal ideation often precedes suicide attempts and suicide. Yet, research involving individuals with lived experience in suicide prevention, especially among young adults, remains scarce. Understanding their needs is crucial for effective interventions. This qualitative study aims to explore the needs and perspectives of young adults with lived experience to provide tailored recommendations for suicide prevention.

Methods

Semi-structured interviews were carried out with 19 young adults who had experienced suicidal ideation within the past two years. Open-ended questions addressed the needs for help and support regarding suicide prevention. Data was thematically analyzed and, through an iterative process involving discussion among all authors, categorized into six themes.

Results

The results indicated needs around more openness and understanding of suicide among the general public, advocating mental health education starting from a young age, reducing barriers in mental health care such as long waiting lists and enhancing informal support systems by facilitating online and offline peer connections. Participants also highlighted contemporary concerns such as social welfare, academic pressure, and social media as significant needs in the current time.

Conclusion

This study highlights the necessity for comprehensive suicide prevention approaches catering to the diverse needs of young adults with recent suicidal ideation. It highlights the urgency of societal awareness, early mental health education, and improved access to services. Informal support networks and addressing societal stressors are also deemed crucial. Structural changes are urged to create supportive environments.

Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT) for US Veterans With Serious Mental Illness: Community Engagement Approach

BACKGROUND

Peer specialists are hired, trained, and accredited to share their lived experience of psychiatric illness to support other similar individuals through the recovery process. There are limited data on the role of peer specialists in suicide prevention, including their role in intervention development.

OBJECTIVE

To better understand peer specialists within the Veterans Health Administration (VHA), we followed partnership community engagement and a formative research approach to intervention development to (1) identify barriers, facilitators, and perceptions of VHA peer specialists delivering a suicide prevention service and (2) develop and refine an intervention curriculum based on an evidence-informed preliminary intervention framework for veterans with serious mental illness (SMI).

METHODS

Following the community engagement approach, VHA local and national peer support and mental health leaders, veterans with SMI, and veteran peer specialists met to develop a preliminary intervention framework. Next, VHA peer specialist advisors (n=5) and scientific advisors (n=6) participated in respective advisory boards and met every 2-4 months for more than 18 months via videoconferencing to address study objectives. The process used was a reflexive thematic analysis after each advisory board meeting.

RESULTS

The themes discussed included (1) the desire for suicide prevention training for peer specialists, (2) determining the role of VHA peer specialists in suicide prevention, (3) integration of recovery themes in suicide prevention, and (4) difficulties using safety plans during a crisis. There were no discrepancies in thematic content between advisory boards. Advisor input led to the development of Suicide Prevention by Peers Offering Recovery Tactics (SUPPORT). SUPPORT includes training in general suicide prevention and a peer specialist-delivered intervention for veterans with SMI at an increased suicide risk. This training aims to increase the competence and confidence of peer specialists in suicide prevention and the intervention supports veterans with SMI at an increased suicide risk through their recovery process.

CONCLUSIONS

This paper intends to document the procedures taken in suicide prevention intervention development, specifically those led by peer specialists, and to be a source for future research developing and evaluating similar interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05537376; https://classic.clinicaltrials.gov/ct2/show/NCT05537376.

Using Large Language Models to Understand Suicidality in a Social Media-Based Taxonomy of Mental Health Disorders: Linguistic Analysis of Reddit Posts

Background

Rates of suicide have increased by over 35% since 1999. Despite concerted efforts, our ability to predict, explain, or treat suicide risk has not significantly improved over the past 50 years.

Objective

The aim of this study was to use large language models to understand natural language use during public web-based discussions (on Reddit) around topics related to suicidality.

Methods

We used large language model-based sentence embedding to extract the latent linguistic dimensions of user postings derived from several mental health-related subreddits, with a focus on suicidality. We then applied dimensionality reduction to these sentence embeddings, allowing them to be summarized and visualized in a lower-dimensional Euclidean space for further downstream analyses. We analyzed 2.9 million posts extracted from 30 subreddits, including r/SuicideWatch, between October 1 and December 31, 2022, and the same period in 2010.

Results

Our results showed that, in line with existing theories of suicide, posters in the suicidality community (r/SuicideWatch) predominantly wrote about feelings of disconnection, burdensomeness, hopeless, desperation, resignation, and trauma. Further, we identified distinct latent linguistic dimensions (well-being, seeking support, and severity of distress) among all mental health subreddits, and many of the resulting subreddit clusters were in line with a statistically driven diagnostic classification system-namely, the Hierarchical Taxonomy of Psychopathology (HiTOP)-by mapping onto the proposed superspectra.

Conclusions

Overall, our findings provide data-driven support for several language-based theories of suicide, as well as dimensional classification systems for mental health disorders. Ultimately, this novel combination of natural language processing techniques can assist researchers in gaining deeper insights about emotions and experiences shared on the web and may aid in the validation and refutation of different mental health theories.

Development of the Mobile Application to Prevent Suicide (MAPS), a Personalized Smartphone App for Suicide Prevention: Feedback from Individual Interviews

The goal of this study was to explore preferences regarding the Mobile Application to Prevent Suicide (MAPS), an ecological momentary intervention smartphone app. We conducted individual interviews with 10 adults hospitalized for suicidal ideation or behavior. In these interviews, we asked about participants' preferences associated with smartphone apps for suicide prevention in general and requested feedback on the specific features of the MAPS intervention. We used line-by-line inductive coding to create a codebook and identify where codes were most prominently displayed. Participants expressed interest in personalized, targeted approaches to suicide prevention, psychoeducation, access to coping strategies, and direct access to crisis services. Involving individuals with lived experience in the early stages is an essential step in the development of a smartphone app for suicide prevention.

A call to action: informing research and practice in suicide prevention among individuals with psychosis

Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.

Promoting mental health among young males in sporting contexts: A systematic review

BACKGROUND

Young males experience markedly poorer mental health outcomes. Organised sport settings provide novel prospects to improve the mental health of this subpopulation.

AIM

This systematic review aimed to evaluate interventions targeted at the promotion of mental health and wellbeing among young males in organised sporting contexts.

METHODS

Six databases (SportDiscus, PsycInfo, Medline, Web of Science, Scopus, CINAHL) were searched from inception to June 2022 (and updated in September 2023). Eligible studies examined interventions targeting the mental health and wellbeing (e.g., depression, anxiety, resilience) or mental health literacy (e.g., stigmatising attitudes, help-seeking) of young males aged 10-24 years (or associated stakeholder samples; e.g., parents or coaches of male youth).

RESULTS

A total of 15 studies were included in this review. Overall, the findings indicate promising effects of sport-based interventions on the mental health and mental health literacy outcomes of young males.

CONCLUSIONS

This review suggests that there is scope to improve the capacity of sports-based interventions to affect positive change in the mental health of male youth. The findings from this review also have important implications for the development and evaluation of sports-based interventions targeted at young males in future.

A qualitative assessment and short-term mediation analysis of defeat, entrapment, and suicide

OBJECTIVES

The Integrated Motivational-Volitional Model (IMV) of Suicide is growing in empirical support. The present study advances IMV research through two aims: (1) to qualitatively probe the subjective experiences of defeat, internal entrapment, and external entrapment, and (2) conducting a 3-month prospective mediation analysis using quantitative and qualitative metrics of defeat and entrapment.

METHODS

The study featured an online two-point survey separated by 3 months. Participants were 255 adults living in the United Kingdom.

RESULTS

Persons endorsing qualitative defeat and internal entrapment in their narratives also showed higher quantitative scores on corresponding IMV and suicide-related self-report scales. Internal entrapment mediated the effect of baseline defeat on 3-month suicidal ideation, whereas external entrapment mediated the association of baseline defeat on 3-month suicide attempt likelihood. Quantitative assessment of entrapment was more significantly associated with suicide attempts and ideation within mediation tests compared to corresponding qualitative variables.

CONCLUSIONS

IMV model principles are largely supported by findings. Mediation results support further consideration of entrapment and defeat within clinical practice and public health-focused suicide research. Understanding the complexity of entrapment narratives represents an important next step for conducting qualitative IMV-focused research with minoritized and high-risk suicide populations.

Validation of the German Version of the P4 Suicidality Tool

For general practitioners (GPs), it may be challenging to assess suicidal ideation (SI) in patients. Although promising instruments exist for the use in primary care, only a few have been validated in German. The objectives of this study were to examine the validity of the brief P4 screener for assessing SI in a cross-sectional study including outpatients. Inclusion criteria were a PHQ-9 score ≥ 10 or an affirmative answer to its SI item. Construct validity of the P4 was examined by comparison with the four-item Suicide Behaviors Questionnaire-Revised (SBQ-R), the PHQ-9 (convergent), and the positive mental health (PMH) scale (divergent). The study sample included 223 patients (mean age 47.61 ± 15 years; 61.9% women) from 20 primary care practices (104 patients) and 10 psychiatric/psychotherapeutic clinics (119 patients). The first three items of the P4 correlate positively with most of the four items of the reference standard SBQ-R (convergent validity); the fourth item of the P4 (preventive factors) correlates significantly with the PMH scale. The most common preventive factor (67%) is family or friends. The German P4 screener can be used to assess SI in outpatient care. It explores preventive or protective factors of suicide, which may support the GP's decision on treatment. We recommend a further clinical interview for patients flagged by P4 assessment in order to more formally assess suicidal risk.

Active involvement of people with lived experience of suicide in suicide research: a Delphi consensus study

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.

Lived experience perspectives guiding improvements to the Systematic Tailored Assessment for Responding to Suicidality protocol

Background and aims

Suicide risk assessment protocols have traditionally been developed by clinical or research experts in suicidology, with little formal involvement of those with a lived experience of suicide. This study broadly aimed to seek lived experience perspectives of the Systematic Tailored Assessment for Responding to Suicidality (STARS) protocol A further aim was to elicit lived experience suggestions for wording and language used in the existing items within sections of the STARS protocol (STARS-p).

Method

Participants were 33 adults (Female = 64%) with a lived experience of suicide, who attended a virtual research workshop at the National Lived Experience of Suicide Summit (2021). After being educated about STARS-p, participants provided their overall perceptions of STARS-p as well as suggestions for rewording and language use across the sections of STARS-p. Their responses were gathered using a virtual online platform for live electronic data collection. A three-phase process of qualitative content analysis was used, engaging both inductive and deductive approaches to explore study aims one and two, respectively. The Consolidated Criteria for Reporting Qualitative Research was followed to enhance quality of reporting.

Results

Qualitative content analysis of participants' views of the STARS-p reflected three main categories, namely, STARS philosophy; What STARS aspires to; and Continuity of care and meeting needs. Responses characterized participants' perceptions of the core purpose of STARS-p and ways for refining or adapting it to suit diverse needs and settings. Based on deductive content analysis, suggested modifications to wording of items and additional items to extend sections were identified.

Conclusion

The study yielded novel perspectives from those with a lived experience of suicide, which will inform improvements to the next edition of STARS-p. The STARS training (required for licensed use of the protocol) will be updated accordingly, in line with these results.

Systems Approach to Suicide Prevention: Strengthening Culture, Practice, and Education

Contemporary approaches to suicide prevention extend beyond an individual's interactions with care providers to seek opportunities for improvement in the wider care system. A systems-based analysis can yield opportunities to improve prevention and recovery across the care continuum. This article uses an example of an individual seeking care in an emergency department to show how a traditional clinical case formulation can be framed in terms of the outer and inner contexts of the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to illuminate the impact of systemic factors on outcomes and to identify opportunities for improvement. Three mutually reinforcing domains (a culture of safety and prevention; best practices, policies, and pathways; and workforce education and development) of a systems approach to suicide prevention are outlined, along with their defining characteristics. A culture of safety and prevention requires engaged, informed leaders who prioritize prevention; lived experience integrated into leadership teams; and adverse events review in a Restorative Just Culture focused on healing and improvement. Best practices, policies, and pathways that promote safety, recovery, and health require codesign of processes and services and evolve through continuous measurement and improvement. To support a culture of safety and prevention, and caring, competent application of policy, organizations benefit from a longitudinal approach to workforce education. This includes a common framework and language; models clinical and lived experience collaboration; and supports continuous learning, as well as onboarding of new staff, rather than following a "one-and-done" approach, so that suicide prevention training remains top of mind across the workforce.

Facilitators and barriers to implementation of suicide prevention interventions: Scoping review

We know that suicide is preventable, yet hundreds of thousands of people still die due to suicide every year. Many interventions were proven to be effective, and dozens of others showed promising results. However, translating these interventions into new settings brings several challenges. One of the crucial obstacles to success is not anticipating possible barriers to implementation nor enhancing possible benefits of factors facilitating the implementation. While we witnessed great support for suicide prevention activities globally in the past years, implementation barriers and facilitating factors are yet to be comprehensively mapped to help implementation activities worldwide. This scoping review maps current knowledge on facilitators and barriers to the implementation of suicide prevention interventions while using the Consolidated Framework for Implementation Research (CFIR) for classification. We included 64 studies. Barriers and facilitators were most commonly identified in the outer setting CFIR domain, namely in the sub-domain of patient needs and resources, which refers to the way in which these needs and resources are reflected by the reviewed interventions. The second most saturated CFIR domain for facilitators was intervention characteristics, where relative advantage, adaptability and cost of intervention sub-domains were equally represented. These sub-domains refer mostly to how the intervention is perceived by key stakeholders, to what extent it can be tailored to the implementation context and how much it costs. While intervention characteristics domain was the second most common also for barriers, the complexity sub-domain referring to high perceived difficulty of implementation was the most frequently represented. With reference to the results, we recommend adapting interventions to the needs of the target groups. Furthermore, carefully selecting the intervention to suit the target context concerning their adaptability, costs and complexity is vital for a successful implementation. Further implications for practice and research are discussed.

Informing and Sustaining Participation of Lived Experience in the Suicide Prevention Workforce

BACKGROUND

Currently, there is no comprehensive study focused on identifying what is needed to support ongoing participation within the suicide prevention lived experience workforce (LEW). It is unclear what specific factors may impede or support ongoing participation in the LEW. The aim of this study was to explore the experiences of suicide prevention LEW in terms of its sustainability.

METHOD

A qualitative interview method was utilised, with a purposive sample of participants who had engaged in the LEW for at least 12 months. The sample comprised 13 individuals (nine females, four males) who engaged in multiple LEW roles, with over half (54%) working in the LEW for more than 5 years. Data were analysed using thematic analysis.

RESULTS

Five main themes were identified: support, passion, personal impact, training, and work diversity. Each theme offers perspectives about the challenges participants face within the suicide prevention LEW.

CONCLUSION

Challenges faced are both similar to those found in the broader MH sector and unique to suicide prevention. Findings suggest that managing expectations of the LEW is important and can inform the creation of guidelines for a supported and sustainable suicide prevention LEW.

Preliminary Evaluation of Lived Experience of Suicide Training: Short-, Medium- and Longer-Term Impacts of Our Voices in Action Training

Despite increased participation and multiple workforce roles of those with lived experience in suicide prevention, there are no evaluated training programs to support this population. This study evaluated a training program aimed to prepare people for these important roles. Survey data at pre-, post- and at three- and 12-month follow-up were used measuring knowledge, attitudes, and self-efficacy, as well as psychological distress as a safety measure. Participants experienced significant gains in knowledge after training, although not all aspects of knowledge were maintained at follow-up. Self-efficacy was examined through confidence and empowerment. Confidence gains were significant at immediate and longer-term follow-up but gains in empowerment were not maintained over time. Participants' positive attitudes improved but this was not significant. There was no indication of increases in psychological distress in participants throughout the training and follow-up periods. Implications of these outcomes are discussed.

Effectiveness of the Hunter Way Back Support Service: An historical controlled trial of a brief non-clinical after-care program for hospital-treated deliberate self-poisoning

INTRODUCTION

Active contact and follow-up interventions have been shown to be effective in reducing repetition of hospital-treated self-harm. The Way Back Support Service (WBSS) is a new service funded by the Australian government to provide three months of non-clinical after-care following a hospital-treated suicide attempt. The aim of this study was to investigate the effectiveness of WBSS in reducing deliberate self-poisoning (DSP) and psychiatric hospital admissions over a 12-month follow-up period for a population of DSP patients within the Hunter (Australia) region.

METHODS

A non-randomized, historical controlled (two periods) trial design with intention-to-treat analyses. Outcome data were drawn from hospital records.

RESULTS

There were a total of 2770 participants across study periods. There were no significant differences between cohorts for proportion with any, or number of, re-admissions for DSP in the follow-up period. For psychiatric admissions, the intervention cohort had a non-significantly greater proportion with any psychiatric admission and significantly more admissions compared to one of the control cohorts.

CONCLUSION

The WBSS model of care should be modified to strengthen treatment engagement and retention and to include established, clinical, evidence-based treatments shown to reduce DSP repetition. Any modified WBSS model should be subject to further evaluation.

Developing a post-discharge suicide prevention intervention for children and young people: a qualitative study of integrating the lived-experience of young people, their carers, and mental health clinicians

BACKGROUND

Suicide in young people is a leading cause of death. Interventions that are reflexive, tailored, and developed in concert with this at-risk population are needed. This study aimed to integrate lived-experience into the design of a suicide prevention intervention delivered by phone to young people post-discharge from an emergency department (ED) for suicide risk or self-harm.

METHODS

Qualitative study was conducted at the Queensland Children's Hospital, Brisbane Australia. Four focus groups with young people with lived-experience, parents or carers and ED mental health clinicals were conducted. In total 5 young people with lived-experience of suicidality (17-21 years, M_age = 19.20), 3 parents and carers with a lived-experience of caring for a young person with mental illness, and 10 ED mental health clinicians participated in focus groups. The first phase of qualitative analysis involved a phenomenological analysis and second phase included a deductive content analysis. The paper is following the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

First phase, a phenomenological analysis identified three foundational themes to structure future follow-up phone interventions: a person-centred focus, the phone-call dynamic, and the phone-call purpose. Second phase, a deductive content analysis found that participants preferred an intervention that was structured, consistent, and finite. Moreover, an intervention that was authentic, able to facilitate and empower growing independence, and achievable of young people after an ED presentation was desired.

CONCLUSIONS

Participants expressed their desire for a responsive, structured, and clearly focused phone call that would recognise the young person and parent/carer's needs while providing tailored support to ease transition from the ED to available community and family led care.

Reddit Users' Experiences of Suicidal Thoughts During the COVID-19 Pandemic: A Qualitative Analysis of r/Covid19_support Posts

Background: The COVID-19 pandemic is having considerable impacts on population-level mental health, with research illustrating an increased prevalence in suicidal thoughts due to pandemic stressors. While the drivers of suicidal thoughts amid the pandemic are poorly understood, qualitative research holds great potential for expanding upon projections from pre-pandemic work and nuancing emerging epidemiological data. Despite calls for qualitative inquiry, there is a paucity of qualitative research examining experiences of suicidality related to COVID-19. The use of publicly available data from social media offers timely and pertinent information into ongoing pandemic-related mental health, including individual experiences of suicidal thoughts. Objective: To examine how Reddit users within the r/COVID19_support community describe their experiences of suicidal thoughts amid the COVID-19 pandemic. Methods: This study draws on online posts from within r/COVID19_support that describe users' suicidal thoughts during and related to the COVID-19 pandemic. Data were collected from creation of this subreddit on February 12, 2020 until December 31, 2020. A qualitative thematic analysis was conducted to generate themes reflecting users' experiences of suicidal thoughts. Results: A total of 83 posts from 57 users were included in the analysis. Posts described a range of users' lived and living experiences of suicidal thoughts related to the pandemic, including deterioration in mental health and complex emotions associated with suicidal thinking. Reddit users situated their experiences of suicidal thoughts within various pandemic stressors: social isolation, employment and finances, virus exposure and COVID-19 illness, uncertain timeline of the pandemic, news and social media, pre-existing mental health conditions, and lack of access to mental health resources. Some users described individual coping strategies and supports used in attempt to manage suicidal thoughts, however these were recognized as insufficient for addressing the multilevel stressors of the pandemic. Conclusions: Multiple and intersecting stressors have contributed to individuals' experiences of suicidal thoughts amid the COVID-19 pandemic, requiring thoughtful and complex public health responses. While ongoing challenges exist with self-disclosure of mental health challenges on social media, Reddit and other online platforms may offer a space for users to share suicidal thoughts and discuss potential coping strategies.

What Works in Community-Led Suicide Prevention: Perspectives of Wesley LifeForce Network Coordinators

Community coalitions have been recognised as an important vehicle to advance health promotion and address relevant local health issues in communities, yet little is known about their effectiveness in the field of suicide prevention. The Wesley Lifeforce Suicide Prevention Networks program consists of a national cohort of local community-led suicide prevention networks. This study drew on a nationally representative survey and the perspectives of coordinators of these networks to identify the key factors underpinning positive perceived network member and community outcomes. Survey data were analysed through descriptive statistics and linear regression analyses. Networks typically reported better outcomes for network members and communities if they had been in existence for longer, had a focus on the general community, and had conducted more network meetings and internal processes, as well as specific community-focused activities. Study findings strengthen the evidence base for effective network operations and lend further support to the merit of community coalitions in the field of suicide prevention, with implications for similar initiatives, policymakers, and wider sector stakeholders seeking to address suicide prevention issues at a local community level.

Our Voices Matter: Using Lived Experience to Promote Equity in Problem Gambling Prevention

Purpose of Review

The field of problem gambling has been historically disconnected from the community experience of gambling and people of color, leading to a lack of integration of those with lived experience into programming. The aim of this article is to describe community-centered efforts to prevent and mitigate harm from problem gambling in Massachusetts—including a pilot program, the Massachusetts Ambassador Project, which is grounded within public health and lived experience frameworks.

Recent Findings

To engage Massachusetts communities in problem gambling prevention, planning processes were conducted to develop culturally appropriate prevention strategies. One of the recurrent themes was the desire of men in the substance misuse recovery community to share their knowledge with others, specifically, men of color who experience racism and health disparities. This finding informed the development of the Ambassador Project, a novel, peer-based, community-centered, and culturally responsive approach for men of color who have a history of substance misuse to engage other men of color in problem gambling prevention.

Two organizations pilot tested the project and reached 4388 individuals. The pilot led to several findings in the design and implementation of related projects. Lessons are shared in three categories: structure, support, and implementation.

Summary

This article demonstrates an innovative approach to connect the field of problem gambling prevention to the community experience, using a public health and social justice lens. Others in the field should acknowledge the disconnect between problem gambling and the lived experience of those disproportionately impacted by creating opportunities for community voice to be at the center of programming.

A Qualitative Analysis of Motivators to Participation in Suicide-Focused Research from a Community-Based Australian Sample

Suicide prevention strategies internationally appear to be falling short of making a meaningful impact on global suicide deaths. Increasing the rates of general community participation in suicide research may improve knowledge generalisability as it relates to suicidal behaviour and leads to new suicide prevention approaches. This study aims to explore the motivations of a community-based sample to participate in suicide research. A subsample of the Australian general population took part in an online survey which is part of a multilevel suicide prevention trial. The survey concluded with an optional open-text question asking about peoples’ motivations for participating in the study; 532 participants left a response to this question. These responses were qualitatively analysed using Thematic Network Analysis. Motivations to participate in suicide research were represented by four global themes: altruism, solve systemic problems, lived experience, and personal benefit. Of these themes, three were focused on the benefit of others, while only the final theme articulated motivation to participate that was self-focused. The impact of suicide is felt throughout the wider community. This new understanding of the motivations of community-based samples to participate in suicide research should be used to increase participation rates and reach people who would not normally contribute their voice to suicide research.