[Suicide prevention in the context of assisted suicide]

The verdict of the German Federal Constitutional Court from 26 February 2020 made it clear that every person is granted the right to end his or her own life, provided it is the person's own free will. It is also within his or her rights to utilize assistance in doing so, if such assistance is offered. This freedom to end one's life and to utilize assistance is not limited to terminal illnesses or situations of unbearable suffering. However, the High Court has also demanded that lawmakers ensure the safety of vulnerable people by making certain that the decision for suicide is in fact made out of the person's own free will. This free decision-making capability can be substantially impaired by acute psychosocial stressors, by mental illnesses but also by third party influence. Therefore, a liberalization of assisted suicide must unconditionally be accompanied by a massive strengthening of suicide prevention measures, which clearly prioritize the help to live over the help to die. This article reviews the scientifically established methods for suicide prevention and makes demands to lawmakers to comprehensively implement such measures.

Are young female suicides increasing? A comparison of sex-specific rates and characteristics of youth suicides in Australia over 2004-2014

Background

Australian mortality statistics suggest that young female suicides have increased since 2004 in comparison to young males, a pattern documented across other Western high-income countries. This may indicate a need for more targeted and multifaceted youth suicide prevention efforts. However, sex-based time trends are yet to be tested empirically within a comprehensive Australian sample. The aim of this study was to examine changes over time in sex-based rates and characteristics of all suicides among young people in Australia (2004–2014).

Methods

National Coronial Information System and Australian Bureau of Statistics data provided annual suicide counts and rates for 10–24-year-olds in Australia (2004–2014), stratified by sex, age group, Indigenous status and methods. Negative binomial regressions estimated time trends in population-stratified rates, and multinomial logistic regressions estimated time trends by major suicide methods (i.e., hanging, drug poisoning).

Results

Between 2004 and 2014, 3709 young Australians aged 10–24 years died by suicide. Whilst, overall, youth suicide rates did not increase significantly in Australia between 2004 and 2014, there was a significant increase in suicide rates for females (incident rate ratio [IRR] 1.03, 95% confidence interval [CI] 1.01 to 1.06), but not males. Rates were consistently higher among Aboriginal/Torres Strait Islander youth, males, and in older (20–24-years) as compared to younger (15–19 years) age groups. Overall, the odds of using hanging as a method of suicide increased over time among both males and females, whilst the odds of using drug-poisoning did not change over this period.

Conclusions

We showed that suicide rates among young females, but not young males, increased over the study period. Patterns were observed in the use of major suicide methods with hanging the most frequently used method among both sexes and more likely among younger and Aboriginal/Torres Strait Islander groups. Findings highlight the need to broaden current conceptualizations of youth suicide to one increasingly involving young females, and strengthen the case for a multifaceted prevention approach that capitalize on young females’ greater help-seeking propensity.

Suicide prevention in Australian Aboriginal communities: a review of past and present programs

A review of Aboriginal suicide prevention programs were conducted to highlight promising projects and strategies. A content analysis of gray literature was conducted to identify interventions reported to have an impact in reducing suicidal rates and behaviors. Most programs targeted the whole community and were delivered through workshops, cultural activities, or creative outlets. Curriculums included suicide risk and protective factors, warning signs, and mental health. Many programs were poorly documented and evaluations did not include suicidal outcomes. Most evaluations considered process variables. Results from available outcome evaluations suggest that employing a whole of community approach and focusing on connectedness, belongingness and cultural heritage may be of benefit. Despite the challenges, there is a clear need to evaluate outcomes if prevention is to be progressed.

Thematic analysis of the experience of group music therapy for people with chronic quadriplegia

BACKGROUND

People living with quadriplegia are at risk for social isolation and depression. Research with other marginalized groups has indicated that music therapy can have a positive effect on mood and social interaction.

OBJECTIVE

To gather descriptions of participants' experience of 2 types of group music therapy - therapeutic singing or music appreciation and relaxation - and to determine commonalities and differences between participants' experience of these 2 methods.

METHODS

We interviewed 20 people with quadriplegia about their experience of participating in 12 weeks of therapeutic singing (n = 10) or music appreciation and relaxation (n = 10). These methods of group music therapy were the interventions tested in a previously reported randomized controlled trial. The interview data were subjected to an inductive thematic analysis.

RESULTS

Six main themes were generated from the interview data. Four of these were shared themes and indicated that both types of group music therapy had a positive effect on mood/mental state and physical state, encouraged social engagement, and reconnected participants with their music identity or relationship with music. In addition, the participants who participated in the singing groups found singing to be challenging and confronting, but experienced a general increase in motivation.

CONCLUSIONS

Group music therapy was experienced as an enjoyable and accessible activity that reconnected participants with their own music. Participants frequently described positive shifts in mood and energy levels, and social interaction was stimulated both within and beyond the music therapy groups.

Review of suicide-prevention programs in Queensland: state- and community-level activities

OBJECTIVE

Information regarding the availability of suicide-prevention programs in Australia is sparse and rather difficult to obtain. This study aimed to report and describe suicide and/or self-harm-prevention programs in Queensland.

METHODS

Programs were classified by type of intervention, predominant type of program, setting of delivery and targeted population-at-risk.

RESULTS

Sixty-six organisations were identified, providing a total of 101 suicide-prevention programs. The majority of programs operated at the prevention or treatment level, with less than half providing continuing (long-term) care. The programs targeted 12 different risk groups and were most frequently delivered within community settings.

CONCLUSIONS

The findings show a diverse distribution of activities across the levels of prevention and different risk populations. This survey demonstrates the existence of remarkable gaps in coverage and provision of programs for specific high-risk groups.

Adolescent suicide in Australia: rates, risk and resilience

Adolescent suicide rates in Australia have fallen significantly during recent years. The incidence, however, clearly remains a serious concern for young people, parents, professionals and policy makers. Some groups of Australian youth appear to be at heightened risk. Adolescents within the welfare system, indigenous, rural and refugee youth, along with same sex attracted young people often need very careful monitoring and support. Young men continue to take their lives more frequently than young women. Prevention programmes in Australia aim to develop resilience in young people, families and communities that can serve as protection against self harm and suicide. The improvement of mental health literacy, a fostering of adolescent self-efficacy and better access to early intervention strategies are currently privileged in national and state policies related to young people in Australia. More work is needed, however, to achieve a well integrated mental health framework capable of effectively addressing adolescent suicide prevention into the twenty-first century.

Spatial analysis of suicide mortality in Australia: investigation of metropolitan-rural-remote differentials of suicide risk across states/territories

Studies of suicide epidemiology in regions of Australia have been conducted, but the spatial pattern in the whole country has not been fully investigated. This study aimed at visualizing the sex-specific suicide pattern over the country from 2004 to 2008, and studying the metropolitan-rural-remote differentials of suicide across all states/territories. We applied a Poisson hierarchical model to yield smoothed sex specific, age standardized mortality ratios of suicide in all postal areas, and compiled the age-standardized suicide rates across different levels of remoteness and different jurisdictions. We identified the area variation of suicide risk across states/territories, and metropolitan-rural-remote differential with rates higher in rural and remote areas for males. Spatial clusters of some high risk postal areas were also identified. Socio-economic deprivation, compositional factors, high risks for Indigenous people and low access to mental health service are the underlying explanations of the elevation of suicide risk in some areas. These findings suggest that it is important to take geographical variations in suicide risk into account in national policy making. Particular suicide prevention interventions might be targeted at males living in remote areas, and some localized areas in metropolitan zones.

Innovations in health service organization and delivery in northern rural and remote regions: a review of the literature

OBJECTIVES

To identify and review innovations relevant to improving access, quality, efficiency and/or effectiveness in the organization and delivery of health care services in rural and remote areas.

STUDY DESIGN

Literature review.

METHODS

Key bibliographic databases that index health research were searched: MEDLINE, EMBASE and CINAHL. Other databases relevant to Arctic health were also accessed. Abstracts were assessed for relevancy and full articles were reviewed and categorized according to emergent themes.

RESULTS

Many innovations in delivering services to rural and remote areas were identified, particularly in the public health realm. These innovations were grouped into 4 key themes: organizational structure of health services; utilization of telehealth and ehealth; medical transportation; and public health challenges.

CONCLUSIONS

Despite the challenges facing rural and remote regions, there is a distinctly positive message from this broad literature review. Evidence-based initiatives exist across a range of areas - which include operational efficiency and integration, access to care, organizational structure, public health, continuing education and workforce composition - that have the potential to positively impact health care quality and health-related outcomes.

Suicide in later life: public health and practitioner perspectives

OBJECTIVES

Suicide in later life is a public health concern. Given the need for practical guidance and policy implementation, this paper aims to provide a critical interpretive synthesis approach to prioritize the likely relevance of publications and the contribution that they make to understanding of the problem.

METHODS

A selective review of the English language literature focusing on the epidemiology of suicide among older people was conducted; the search strategy built on that of a previous review. Papers were selected for their ability to shed light on the potential for prevention and practice from public health perspectives.

RESULTS

Whilst the majority of older people who commit suicide have major depression, suicide seems to be due to a combination of personality factors and co-morbidities, including chronic pain and disablement. Complex multi-component public health studies are underway and are likely to provide useful knowledge to guide practice more precisely, but there is remarkably little information about the involvement of older people in risk reduction or about harm minimization approaches at patient and public participation levels.

CONCLUSIONS

For lack of sufficient evidence from intervention trials that are specific to older people, practitioners need to extrapolate from studies of younger adults and be aware of risk factors for suicide in later life. Public health approaches combined with practitioners' experiences of older people at risk may help minimize the risks of suicide in later life. These are fruitful areas for collaborative practice development, service initiatives, evaluation, and research.