Digital-based mobile interventions hold significant promise in preventing suicide. Although mixed, some evidence suggests these interventions are effective and capable of overcoming barriers such as cost and stigma. This review aimed to determine the effectiveness of digital interventions designed to address suicidal ideation and behaviors and the impacts of age, gender, and control group type on these outcomes. Databases were searched for randomized controlled trials (RCTs) on digital suicide interventions (apps/online programs) published before January 1, 2022. Data were analyzed using a random-effects model in Stata 17. The search identified 4,317 articles, and 16 were included. Risk of bias analysis found studies to be of low-to-moderate quality. The random-effects model indicated a small but significant effect of treatment on suicidal ideation, = 16, = 0.11 (95% CI: 0-0.23), = .049. Subgroup analyses found the interventions to have a significant effect on adults ( = 0.15, 95% CI: 0.03, 0.28, = .01) but not adolescents. The interventions showed better effects compared to waitlist controls ( = 0.28, 95% CI: 0.19, 0.38) but not compared to treatment as usual or active controls [χ(2) = 29.41, < .001]. Sample sizes across studies were insufficient for examining the effectiveness of digital interventions by gender. Limited studies reported on suicidal behaviors, so the impact of digital interventions on these behaviors could not be analyzed. This review found a significant effect of digital interventions for reducing suicidal ideation and highlights the importance of examining the effectiveness across subgroups.

Suicide bereavement increases the probability of adverse outcomes related to grief, social functioning, mental health, and suicidal behavior. While more support for individuals bereaved by suicide has become available, the evidence regarding its effectiveness is not straightforward. The literature suggests that identifying best-practice components is key in designing effective postvention interventions. This metareview aims to identify components of suicide bereavement interventions perceived to be effective by suicide-bereaved people. The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Systematic searches in Medline, PsycINFO, Embase, Emcare, EBM Reviews, Scopus, and Web of Science identified 11 eligible systematic reviews published between 2008 and 2023. The methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2) (PROSPERO registration CRD42023458300). Our narrative synthesis reported the components perceived to be effective in relation to structure and content of interventions, facilitators, and modality (peer, group, community, online). The quality of the included reviews varied considerably, and not all reviews reported on perceived effectiveness of interventions' components. Meta-analysis of findings was not possible due to study heterogeneity. The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.

Suicide bereavement is associated with complex emotional challenges, stigma, and elevated risk of subsequent suicide. Early responders are often the first to interact with or inform survivors of the death. Thus, these interactions hold the potential to shape their loss experience, pursuit of support services, and healing process. Yet, a few studies explore these interactions in depth. This study investigates the interactions between suicide loss survivors and early responders within 72 h of loss and their impact on the pursuit of mental health and support services. The study employs a cross-sectional survey of 120 suicide loss survivors. Survivors who sought mental health support reported higher levels of compassionate communication, personal disclosures, follow-up interactions, information sharing, and referrals. : A demographically homogenous sample primarily consisting of white females limits generalizability. The small sample size and reliance on survey data constrained statistical analyses. These findings underscore the importance of early responder interactions in suicide postvention and support the potential effectiveness of active postvention models.

This study examined if firefighters (an occupational group at elevated suicide risk) who have made a suicide plan involving a firearm reported higher suicidal intent than those whose plans did not involve a firearm. Participants included 173 firefighters ( [] age = 32.0 [9.9], 95.8% male) who reported having made a suicide plan during their tenure as firefighters. We used a self-report version of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) to determine the presence and nature of suicide plans during firefighter tenure. We used Item 4 of the Suicidal Behaviors Questionnaire-Revised (SBQ-R) to assess suicidal intent. Overall, 44.5% of suicide plans involved firearms. Firefighters who reported a suicide plan involving a firearm reported significantly higher mean levels of suicidal intent than firefighters who did not report a suicide plan involving a firearm. This investigation relied on a cross-sectional convenience sample which limits our ability to establish causal claims. Firefighters who report a suicide plan specifically using a firearm may represent an especially at-risk group. Clinicians should assess for both suicidal intent and means during risk assessments and deliver rigorous lethal means safety counseling to mitigate suicide risk among firefighters.

Suicide is a major public health concern globally, and despite decades of research, there has been a disappointing lack of progress in identifying effective prevention strategies and interventions. We argue over-reliance on traditional statistical significance cutoffs and underreporting of marginal findings may be limiting the clinical benefits of research in the field of suicide prevention and in turn impeding practical progress. The consistent reliance on results at < .05 may limit the visibility of potentially promising results to clinicians making treatment decisions. Expanding awareness of promising interventions - which can then be further scrutinized and subjected to further research - could have an important and needed impact on the field. The American Statistical Association has called upon researchers to view the -value as continuous, with the call being adopted by leading journals. However, most suicide journals do not have explicit policies around how to use -values for evaluating the strength of the evidence, and the use of continuous -values has clearly not been routinely adopted by suicide researchers. We want to call upon suicide researchers to be more open to considering and publishing marginally significant findings that suggest promising trends for suicide prevention strategies and interventions.

Call centers offering social services receive calls from a diverse range of people with varied presenting concerns. Although these centers are not typically designed to assist callers in crisis, unlike suicide prevention or crisis lines, they still encounter a small but significant number of calls from people in active crisis. This article serves as a case study to highlight the importance of crisis intervention readiness and to provide guidelines for non-crisis-oriented call centers on managing crisis calls. It features procedures used by Kick It California (KIC), a tobacco cessation quitline, as a sample blueprint. KIC's crisis management protocol is offered, including guidelines for assessing risk levels and implementing emergency procedures. Additionally, the article outlines strategies for quality assurance as well as ethical and legal considerations, as foundational elements for crisis management procedures in social service call centers.

: Suicide remains a taboo subject for many people in Ghana, buried in cultural beliefs. Suicide deaths are frequently addressed without regard for the effect such events have on the bereaved relatives. To explore what is known about suicide in Ghana and how suicide bereavement might impact families. Narrative review based on a thorough literature search in PsycINFO, Scopus, and PubMed. Gray literature as well as organizational reports and newspaper articles were also included. Demographics, trends, patterns, and factors for suicidal behavior are explored. The findings are contextualized within the Ghanaian social context of suicide and the ramifications for the bereaved individuals. Suicidal behavior is influenced by elements in an individual's micro- and macro-systems, such as conflicting relationships, poor academic achievement, cultural practices, the death of a spouse, and socioeconomic reasons. These variables render a death by suicide more challenging for the bereaved. The findings cannot be generalized to other countries. The devastating impact of suicide bereavement in Ghana must be understood within a sociocultural context. Nonetheless, few studies have investigated the experiences of suicide loss survivors, leaving a substantial gap in the understanding and development of postvention and suicide bereavement support in this country.

Passive and active suicidal ideation (SI) have been shown to be co-occurring but are distinguishable constructs with presumably differential sets of predictors. The present analysis integrates nomothetic and idiographic analyses to unravel the relations between passive and active SI and momentary affective states in real-time data to tap several knowledge gaps. 54 psychiatric inpatients rated their current passive and active SI and positive as well as negative affect for six consecutive days (10 random prompts daily) using ecological momentary assessments on smartphones. Data were analyzed using group iterative multiple model estimation (GIMME). On subgroup level, only significant contemporaneous paths emerged (with no direct paths from affect to active SI). In general, the personalized models revealed large heterogeneity. The number, direction, and strengths of individual paths differed enormously (with fewer direct paths from affect to active SI than to passive SI overall). Passive and active SI were interrelated in the majority of individual models. : Findings are limited by item wording, co-occurence of passive and active SI, and the short observation interval. The heterogeneous individual models potentially reflect structural and functional differences in the development and maintenance of SI.

Veterans die by suicide at higher rates than their civilian counterparts. Given this, it is likely veterans also experience high rates of suicide exposure. The purpose of this study was to explore suicide exposure in veterans and its impact on mental health. Survey data were collected from 3,188 veterans. Data were collected online using a multipronged sampling strategy. Suicide exposure, PTSD, depression, and suicide risk were measured in the survey. Odds ratios were produced through a series of bivariate logistic regressions. Just under 60% (59.2%) of veterans reported experiencing exposure to suicide, with the majority of participants indicating multiple exposures. Veterans exposed to suicide were twice as likely to meet criteria for PTSD, depression, and suicide risk. : The use of convenience samples and the geographically distinct sampling area may limit the generalizability of the findings. The fact that the survey used self-reported measures, the inability to infer causality, and the severity of exposure were also limitations. Findings demonstrate veterans may be exposed to suicide at high rates and that exposure may create increased risk for negative mental health outcomes. Results have implications for risk assessment, intervention after suicide exposure as well as suicide prevention efforts.

Adolescent suicide is a growing social issue in South Korea, exacerbated by a decreasing adolescent population and rising suicide attempt rates. This study investigates the direct effects of school and parental factors on suicidality in South Korean adolescents and their indirect effects through psychological factors. Using data from 4,650 adolescents who participated in the 2021 Survey on the Mental Health of Teenagers, this study set school factors as school attachment, teacher attachment, and peer attachment; parental factors as parental neglect, interference, and abuse; and psychological factors as depression, anxiety, and strain. Structural equation modeling was used for analysis. School and parental factors had no direct impact on suicidality. However, weak school attachments and negative parental behaviors increased psychological distress, indirectly raising suicidality among adolescents. : This study could not use all the factors mentioned in the social bonding theory and general strain theory as factors affecting suicidality in the analysis, and the findings are limited to cross-sectional data. This study highlights the importance of addressing school, parental, and psychological factors in adolescent suicide. Government, schools, and families must collaborate to improve adolescent mental health through prevention policies, counseling, stress-relief programs, and enhanced communication.

The literature is scant on the associations between employment-related variables and suicidal ideation. The objectives were to explore these associations in the national French working population. The study relied on two independent national French surveys and their samples of 22,420 workers (employees and self-employed workers) and 25,628 employees, respectively. Employment variables included occupation, economic activity of the company, public/private sector, company size, permanent/temporary work, full/part time, seniority, and employee/self-employed worker. Suicidal ideation was assessed using one item. The associations between employment variables and suicidal ideation were studied using bi- and multivariable weighted analyses (Rao-Scott Chi-2 test and logistic regression). Gender differences were explored and covariates were taken into account. : The associations between employment variables and suicidal ideation were mostly not statistically significant. Some differences in suicidal ideation between occupations and economic activities were difficult to interpret due to overlaps in the confidence intervals. The prevalence of suicidal ideation increased with seniority among employees. The study design was cross-sectional. The studied employment variables may have little effect on suicidal ideation. As suicidal ideation is a risk factor for suicide, more research is needed to explore the work-related risk factors for suicide and suicidal ideation.

Exposure to suicide is associated with a range of psychosocial harms which Australian employers have a legislated responsibility to mitigate. Examine the impact of suicide on staff, current workplace responses and the efficacy of a new, systemic model of workplace postvention. Interviews and focus groups with 54 staff in 22 workplaces from the commercial, government, and not-for-profit sectors. Every participant had experienced the suicide of a client or colleague and reported a range of short- and long-term negative impacts, including suicidal ideation. This contrasted with the overall lack of workplace postvention, which increased the risks of psychosocial harms to staff. The new model was effective in tailoring a systemic approach to workplace postvention. The small size of the sample limits generalizability; however, the prevalence of exposure to suicide and lack of workplace preparedness were strikingly consistent. The impact of suicide on staff is significant and current workplace responses are ineffective and potentially harmful. The new model improves staff and workplace preparedness through tailored and co-designed training, governance and supports.

Crisis supporters can experience numerous stressors in their role that can impact their own mental well-being. The area remains underexplored in research, particularly relating to substance use, and new trends in the role such as working remotely or the impact of providing chat-based support. This study identifies crisis support-related stressors, as well as levels of mental well-being and substance use, and factors associated with mental well-being. Participants ( = 422) were recruited from four leading crisis support services and via social media advertising. They responded to an online survey, assessing demographics, stressors, mental well-being (compassion fatigue, compassion satisfaction, and psychological distress), substance use, and coping styles. Findings identified several important stressors (e.g., argumentative callers) and moderate to high rates of compassion fatigue and psychological distress. High levels of compassion satisfaction were reported, and levels of risky substance use were low. Problem-focused coping emerged as a key factor related to positive mental well-being, while emotion-focused, avoidant coping, remote work, and providing chat-based support were linked to negative well-being. The study's cross-sectional design and convenience sample limit causal inferences and generalizability. The findings reveal significant stressors and challenges in crisis supporters that require consideration and intervention.

: Suicide risk is elevated among first responders. The three-step theory of suicide (3ST), not yet tested in first responders, proposes that the combination of pain and hopelessness leads to suicidal desire, but most relevant studies examine psychological pain and a few studies exist regarding the impact of physical pain. : This study aimed to replicate and expand the understanding of the 3ST by examining physical and psychological pain in Step 1 within first responders. : First responders ( = 204) completed an anonymous online survey assessing physical pain, psychological pain, hopelessness, and suicidal desire. Moderation analyses were used to test whether psychological pain and physical pain, respectively, potentiate the relationship between hopelessness and suicidal desire. : Physical pain moderated the relationship between hopelessness and suicidal desire, such that high levels of physical pain potentiated the relationship and low levels diminished the relationship, while psychological pain did not. Findings support the 3ST and provide evidence for the important role of physical pain in examining suicidal desire among first responders. and : Although data were cross-sectional, results may inform development of measures tailored to first responders, which could ultimately lead to improved methods for assessing critical components of first responder and suicide risk.

Men account for 75% of all suicide deaths in Australia. Societally dominant masculine norms have been theorized to be linked with suicidality and reduced help-seeking. However, evidence is needed to establish this relationship further. To further understand the relationships between 11 masculine norms, suicidal ideation, and mental health help-seeking behavior longitudinally in Australian males. We analyzed data from a cohort of 8,214 males (aged 18-55 years), using logistic regression to examine if conformity to any of the 11 masculine norms measured by the Conformity to Masculine Norms Inventory (CMNI-22) at Wave 1 was associated with suicidal ideation and help-seeking at Wave 2. Analyses revealed that being in the high conformity group for the norm of emotional control at Wave 1 was associated with higher odds of suicidal ideation longitudinally. Being in the low conformity group for the global construct of masculine norms and the specific norms of emotional control and power over women was associated with higher rates of mental health help-seeking behavior longitudinally. The CMNI-22 scale's limited construct validity and the use of a single-item measure for suicidal ideation may have restricted the accurate capture of masculine norms and suicidal behaviors in Australian men. These results provide support for the contention that suicidality is a profoundly gendered phenomenon by showing an association between masculine norms and suicidal ideation in men. These norms should be a point of focus of male suicide prevention initiatives.

: While there is substantial literature on gender and research productivity, bearing mixed results, no study is available for suicidology. The present investigation fills this gap and focuses on an influential elite. : Data are taken from the Web of Science (WoS). They refer to the most prolific suicidologists ( = 116) with 70 or more works on the subject of suicide cited in WoS. Measures of research productivity include the number of works on suicide, citations to these works, and the h-index. The link between gender and the measures of research productivity is adjusted for years of experience, membership in a local research cluster, and region of the world. : Adjusting for the other predictors, males had more publications than females. However, gender did not predict either measure of quality of research (citations, h-index). Years of experience, as well as membership in a research cluster, predicted research productivity in most analyses. Region was unrelated to research productivity. : Further work on productivity might assess additional potential predictors including marital status, grant funding, and presence of young children. : There is no significant difference between the genders in research quality. Similar results have been noted in previous work on prolific scientists.

In 2018, news outlets began reporting on a suicide epidemic among New York City's yellow taxi drivers. Within months, print, television, radio, and internet outlets had produced pieces describing the deaths of drivers struggling to endure transformations in their industry. We explored taxi drivers' perspectives regarding suicide news coverage and the degree to which the coverage affected their lives. Current and recent taxi drivers participated in open-ended, life-history-informed interviews, which were transcribed and analyzed thematically. We interviewed 21 participants. Four themes related to interviewees' experience of suicide-related media coverage emerged: drivers' awareness of the news coverage and opinions regarding it, the degree to which the coverage motivated drivers to engage in conversation with others about stress, the extent to which coverage inspired drivers to think differently about mental health, and perceptions regarding the media's broader characterization of taxi drivers. Interviews were conducted in English, a second language for many taxi drivers. Taxi drivers expressed diverse views regarding media reporting on driver suicides, with some viewing it as helpful, while others critiqued it as simplistic, stigmatizing, and sensationalist.

Prevention strategies for suicide emphasize restrictions on firearm access. These restrictions may lose efficacy if individuals substitute other lethal suicide methods. The objective of this study is to determine the extent to which individuals who die by suicide in the United States substitute hanging for firearm injury. This study is a repeated cross-sectional analysis of suicide deaths in the United States from 2003 to 2021. Multiple regression was used to estimate the effect of firearm access proxies on individual suicide methods (hanging vs. firearm injury). The probability of death by hanging was significantly and negatively associated with proxies of firearm access. This study does not compare crude rates of suicide by state, which rise on average with rates of firearm ownership. The National Violent Death Reporting System expanded over the sample period, so early years have incomplete ascertainment. Rates of gun ownership and gun safety law scales are measured as proxies. Although means restriction around firearm access is a critical tool for suicide prevention, complementary strategies for prevention around hanging merit further study.

The use of positive coping skills has demonstrated protective effects with regard to Nonsuicidal Self-Injury (NSSI) engagement; however, cross-sectional evidence suggests that the presence of comorbid conditions, such as alcohol use disorders, may negate these benefits. The current study leverages ecological momentary assessment (EMA) to examine the between-person and within-person relationships between positive coping strategies and NSSI risk among individuals with problematic alcohol use. Undergraduate students ( = 56) completed a 21-day EMA protocol, in which they completed four surveys per day asking about their use of several positive coping strategies and NSSI risk. Socializing was the only coping strategy to demonstrate a protective effect on NSSI risk. Alternatively, the coping strategies of finding perspective, positive thinking, and sitting with feelings until they pass all increased risk for NSSI. The current study was underpowered to disentangle relationships with urges to engage in NSSI and NSSI behaviors. The results suggest that using coping skills that may present physical barriers to engaging in NSSI may be effective for reducing momentary NSSI risk.

: While Gatekeeper Training (GKT) is an accepted component of suicide prevention strategies, there is little evidence about its effectiveness with Indigenous populations and online. : This study examined the effects of LifeKeepers, a novel GKT, comprising three modalities: General, e-learning, and a culturally tailored Māori (New Zealand Indigenous) training. : A total of 5,981 participants completed measures of declarative knowledge, perceived knowledge, and self-efficacy pre- and post-training. Participants rated satisfaction with LifeKeepers, its safety considerations and cultural acceptability post-training. : There were statistically significant improvements across all outcome measures (declarative knowledge 1.3 [95% CI 1.3-1.4], perceived knowledge 10.9 [95% CI 10.7-11.1], and self-efficacy 2.5 [95% CI 2.5-2.6]), including across all modalities. More than 90% of participants rated satisfaction, cultural acceptability, and safety considerations highly. Without a control group, changes may not be solely due to engagement in LifeKeepers. : This study offers preliminary evidence of the immediate effectiveness of LifeKeepers, across its in-person, Indigenous Māori, and e-learning modalities. It addresses a critical literature gap by exploring participants' safety perspectives and strongly supports LifeKeepers as a primary suicide prevention intervention in New Zealand, especially for Indigenous Māori communities. Comparable outcomes for e-learning participants indicate wider accessibility, bolstering suicide prevention efforts.

Real-time suicide registers are being established in many countries and enable regular monitoring of suspected suicides over time. The use of these data to monitor for suicide clusters is in its infancy. We sought to test the feasibility of using real-time suicide register data to detect spatiotemporal suicide clusters. Using the Victorian Suicide Register and SaTScan's spatiotemporal scan statistic, we simulated a monthly search for clusters from January 2015 to June 2022 using rolling 2-year windows of data in each search. Monthly scans were performed at three different levels of geographic granularity and for all-ages and under-25 populations. Our results indicated the rapid identification of possible suicide clusters and demonstrated a practical approach to combining real-time suicide data and scanning algorithms. We developed new model outputs that showed cluster timelines. The main limitations are that the computational burden of fitting multiple models meant we were unable to scan for ellipses and other irregular shapes and we were unable to consider space-time permutation models. Using data from a real-time suicide register, we were able to scan for space-time suicide clusters simulating the situation where the data are updated monthly with new updates.

Prior work has explored the impact of follow-up calls in a crisis line context, but no research has investigated the offer and acceptance of follow-up care. To identify caller/call characteristics associated with whether a caller is offered and accepts follow-up services. : This cross-sectional study included data from 55,594 callers to a member center of the 988 Suicide & Crisis Lifeline (988) between 2017 and 2019. Logistic regression analyses were conducted to examine associations between caller/call characteristics and two follow-up outcomes. : Black callers and those with higher suicide capability and intent had greater odds of being offered and accepting follow-up. Longer call duration was also associated with higher odds of being offered and accepting follow-up. Higher suicidal desire uniquely increased the odds of offers, whereas a higher level of buffers uniquely decreased the odds of offers. Data were collected from a single 988-member center and cannot be generalized. : That one-third of callers do not accept follow-up highlights the need to understand reasons for not accepting follow-up. That callers with higher risk profiles are offered and accept follow-up at higher rates is reassuring and underscores the benefit of tailoring follow-up interventions for higher-risk callers.

Since its creation in 2007, the Veterans Crisis Line (VCL) has provided 24/7, confidential crisis support services for Veterans, Service Members, and their families, supporting the VA's highest clinical priority of suicide prevention. As part of this effort, VCL created the (CWCN) program to manage the individual needs and operational impact of VCL customers who call at a high frequency, are abusive toward hotline staff, exhibit sexually inappropriate behavior, and/or make threats of violence. This paper describes the VCL CWCN program and customer characteristics. Call data from 2012 to 2022, including operational data for 1,096 CWCN customers identified from October 2017 to December 2020, were used for analysis. At the cohort's peak size in 2020, calls from CWCN customers accounted for 0.4% of all distinct phone numbers received by VCL and for 22.1% of total VCL call volume. Implementation of the CWCN program was associated with significant annual reductions in average individual call volume among high frequency callers. However, no change in call volume was observed among nonhigh frequency callers. Formative challenges and future directions for the CWCN program and implications for other crisis lines are discussed.

Despite men's high suicide risk, gender perspectives in suicide prevention research are scarce. The goal of this systematic review was to describe the desirable and adverse effects of distribution channels and message strategies of communicative suicide prevention interventions among men. Databases PubMed and Web of Science were searched for quantitative randomized controlled trials (RCTs) and nonrandomized studies examining the effectiveness of male-specific or general communicative interventions among men. Narrative synthesis was used to summarize findings. Fifty-five studies published in peer-reviewed articles until October 15, 2021, were included. Findings demonstrate that interpersonal, mass media, and digital media interventions impact suicide-related outcomes preventively. Mass media interventions are not suitable to impact men's emotions in a prevention-desirable way. Message strategies interactivity, emotional appeals, and clear calls to action demonstrated high effectiveness, while expert exemplars, visualizations, and personalization were rather ineffective. However, the review was not able to prove causality, could not distinguish between multichannel interventions and single-channel interventions, or between specific combinations of channels and message strategies. The systematic review provides some guidance on which channels and message strategies to apply in communicative suicide prevention for men.