International Journal of Environmental Research and Public Health

Research

16 pages, 1601 KiB

Open AccessArticle

A Mixed-Methods Evaluation to Inform the Hawaiʻi Suicide Prevention Strategic Plan

by Saikaew Dudla, Tarin T. Tanji, Jeanelle Sugimoto-Matsuda, Jane J. Chung-Do, Eric Agluba, Tricia Khun, Shivani Trivedi and Deborah Goebert

Int. J. Environ. Res. Public Health 2024, 21(5), 565; https://doi.org/10.3390/ijerph21050565 - 29 Apr 2024

Viewed by 1529

Abstract

The Prevent Suicide Hawaiʻi Taskforce is a state, public, and private partnership of individuals, organizations, and community groups that leads statewide suicide prevention efforts in Hawaiʻi. The purpose of this evaluation was to identify the progress and barriers of the Taskforce to inform [...] Read more.

The Prevent Suicide Hawaiʻi Taskforce is a state, public, and private partnership of individuals, organizations, and community groups that leads statewide suicide prevention efforts in Hawaiʻi. The purpose of this evaluation was to identify the progress and barriers of the Taskforce to inform the upcoming 2025 Hawaiʻi Suicide Prevention Strategic Plan in the following areas: Hope, Help, Heal, Research and Evaluation, and Policy and Advocacy. Utilizing a sequential exploratory mixed-methods approach, 18 key informants were interviewed, followed by a 13-question survey sent to the Taskforce member listserv. Results were analyzed using qualitative coding techniques and descriptive statistics. Interview findings contained six themes: importance of community relationships, interconnection of suicide prevention efforts, progress in diversifying training, organizational challenges, adaptations to the COVID-19 pandemic, and funding challenges. Of the 34 survey respondents, most were involved in the area of Hope (91%). The respondents reported the area with most progress was Hope (87%), and the most important area to address was Help (41%). The majority (82%) of the respondents characterized the level of Taskforce communication as Excellent or Good. Interview and survey data corroborated each other and revealed new insights about the successes and barriers of the Taskforce and their progress in implementing the Strategic Plan. Recommendations included advocating for long-term funding for suicide prevention and building community relationships. Full article

(This article belongs to the Special Issue Suicide in Asia and the Pacific)

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12 pages, 1191 KiB

Open AccessArticle

Attempted Suicide Is Independently Associated with Increased In-Hospital Mortality and Hospital Length of Stay among Injured Patients at Community Tertiary Hospital in Japan: A Retrospective Study with Propensity Score Matching Analysis

by Yuko Ono, Tokiya Ishida, Nozomi Tomita, Kazushi Takayama, Takeyasu Kakamu, Joji Kotani and Kazuaki Shinohara

Int. J. Environ. Res. Public Health 2024, 21(2), 121; https://doi.org/10.3390/ijerph21020121 - 23 Jan 2024

Cited by 1 | Viewed by 2079

Abstract

Suicide is an increasingly important public healthcare concern worldwide. Studies examining the effect of attempted suicide on clinical outcomes among patients with trauma are scarce. We conducted a retrospective cohort study at a community emergency department in Japan. We included all severely injured [...] Read more.

Suicide is an increasingly important public healthcare concern worldwide. Studies examining the effect of attempted suicide on clinical outcomes among patients with trauma are scarce. We conducted a retrospective cohort study at a community emergency department in Japan. We included all severely injured patients with an Injury Severity Score > 15 from January 2002 to December 2021. The primary outcome measure was in-hospital mortality. The other outcome of interest was hospital length of stay. One-to-one propensity score matching was performed to compare these outcomes between suicide attempt and no suicide attempt groups. Of the 2714 eligible patients, 183 (6.7%) had trauma caused by a suicide attempt. In the propensity score-matched analysis with 139 pairs, the suicide attempt group showed a significant increase in-hospital mortality (20.9% vs. 37.4%; odds ratio 2.27; 95% confidence intervals 1.33–3.87) compared with the no suicide attempt group. Among survivors, the median hospital length of stay was significantly longer in the suicide attempt group than that in the no suicide attempt group (9 days vs. 12 days, p = 0.0076). Because of the unfavorable consequences and potential need for additional healthcare, increased attention should be paid to patients with trauma caused by a suicide attempt. Full article

(This article belongs to the Special Issue Suicide in Asia and the Pacific)

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17 pages, 364 KiB

Open AccessArticle

Studying Scripts of Women, Men and Suicide: Qualitative-Method Development and Findings from Nepal

by Silvia Sara Canetto, Andrew D. Menger-Ogle and Usha Kiran Subba

Int. J. Environ. Res. Public Health 2023, 20(11), 6032; https://doi.org/10.3390/ijerph20116032 - 1 Jun 2023

Cited by 2 | Viewed by 3006

Abstract

Information about suicidal behavior in Nepal is limited. According to official records, suicide rates were high until the year 2000 and declined thereafter. Official records are considered unreliable and a gross undercounting of suicide cases, particularly female cases. Suicide research in Nepal has [...] Read more.

Information about suicidal behavior in Nepal is limited. According to official records, suicide rates were high until the year 2000 and declined thereafter. Official records are considered unreliable and a gross undercounting of suicide cases, particularly female cases. Suicide research in Nepal has been mostly epidemiologic and hospital-based. Little is known about how suicide is understood by Nepali people in general—including dominant suicide attitudes and beliefs in Nepal. Suicide attitudes and beliefs, which are elements of a culture’s suicide scripts, predict actual suicidality. Drawing on suicide-script theory, we developed and used a semi-structured survey to explore Nepali beliefs about female and male suicide. The informants were adult (M_age = 28.4) university students (59% male). Female suicide was believed to be a response to the society-sanctioned oppression and abuse that women are subjected to, in their family and community. The prevention of female suicide was viewed as requiring dismantling ideologies, institutions, and customs (e.g., child marriage, dowry) that are oppressive to women, and ensuring that women are protected from violence and have equal social and economic rights and opportunities. Male suicide was believed to be a symptom of societal problems (e.g., unemployment) and of men’s psychological problems (e.g., their difficulties in managing emotions). The prevention of male suicide was viewed as requiring both societal (e.g., employment opportunities) and individual remedies (e.g., psychological counseling). This study’s findings suggest that a semi-structured survey can be a fruitful method to access the suicide scripts of cultures about which there is limited research. Full article

(This article belongs to the Special Issue Suicide in Asia and the Pacific)

17 pages, 515 KiB

Open AccessArticle

Fatigue on Waking, Insomnia, and Workplace Relationship Problems May Help to Detect Suicidal Ideation among New Middle-Aged Primary Care Patients: A 6-Month Prospective Study in Japan

by Megumi Fujieda, Katsuhisa Uchida, Shinichiro Ikebe, Akihiro Kimura, Masashi Kimura, Toshiaki Watanabe, Hisako Sakamoto, Teruaki Matsumoto and Naohisa Uchimura

Int. J. Environ. Res. Public Health 2023, 20(8), 5547; https://doi.org/10.3390/ijerph20085547 - 17 Apr 2023

Viewed by 2443

Abstract

Signs of suicidal depression often go undetected in primary care settings. This study explored predictive factors for depression with suicidal ideation (DSI) among middle-aged primary care patients at 6 months after an initial clinic visit. New patients aged 35–64 years were recruited from [...] Read more.

Signs of suicidal depression often go undetected in primary care settings. This study explored predictive factors for depression with suicidal ideation (DSI) among middle-aged primary care patients at 6 months after an initial clinic visit. New patients aged 35–64 years were recruited from internal medicine clinics in Japan. Baseline characteristics were elicited using self-administered and physician questionnaires. DSI was evaluated using the Zung Self-Rating Depression Scale and the Profile of Mood States at enrollment and 6 months later. Multiple logistic regression analysis was conducted to calculate adjusted odds ratios for DSI. Sensitivity, specificity, and likelihood ratios for associated factors were calculated. Among 387 patients, 13 (3.4%) were assessed as having DSI at 6 months. Adjusted for sex, age, and related factors, significant odds ratios for DSI were observed for “fatigue on waking ≥1/month” (7.90, 95% confidence intervals: 1.06–58.7), “fatigue on waking ≥1/week” (6.79, 1.02–45.1), “poor sleep status” (8.19, 1.05–63.8), and “relationship problems in the workplace” (4.24, 1.00–17.9). Fatigue on waking, sleep status, and workplace relationship problems may help predict DSI in primary care. Because the sample size in this investigation was small, further studies with larger samples are needed to confirm our findings. Full article

(This article belongs to the Special Issue Suicide in Asia and the Pacific)

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13 pages, 318 KiB

Open AccessArticle

Gendered Antecedents and Consequences of Young Women’s Suicidal Acts in Sri Lanka

by Jeanne Marecek and Chandanie Senadheera

Int. J. Environ. Res. Public Health 2023, 20(4), 2885; https://doi.org/10.3390/ijerph20042885 - 7 Feb 2023

Cited by 4 | Viewed by 1977

Abstract

In the late 1990s, Sri Lanka had a record rate of suicide deaths. Since then, deaths have decreased dramatically due to the restriction of lethal agrochemicals. The number of nonfatal suicidal acts, however, remains extraordinarily high. A disproportionate number of these cases are [...] Read more.

In the late 1990s, Sri Lanka had a record rate of suicide deaths. Since then, deaths have decreased dramatically due to the restriction of lethal agrochemicals. The number of nonfatal suicidal acts, however, remains extraordinarily high. A disproportionate number of these cases are adolescents and young adults—mainly girls and young women. This paper offers a close look at adolescent girls in rural Sri Lanka who had engaged in nonfatal suicidal acts. We carried out interviews with daughters and mothers while the girls were receiving medical care following a suicidal act. Drawing from these interviews, we describe the circumstances leading to girls’ suicidal acts, the responses and moral judgments made by adult family members, and the reputational and social consequences of these acts. Few girls intended to die; none had previously undertaken a suicidal act, and none gave evidence of “mental illness”. In many cases, girls’ suicidal acts were triggered by acute family conflicts, often concerning situations that were seen to compromise the girl’s sexual respectability and the honor of her family. Full article

(This article belongs to the Special Issue Suicide in Asia and the Pacific)

14 pages, 2809 KiB

Open AccessArticle

The Impact of the COVID-19 Pandemic and Lockdowns on Self-Poisoning and Suicide in Sri Lanka: An Interrupted Time Series Analysis

by Thilini Rajapakse, Tharuka Silva, Nirosha Madhuwanthi Hettiarachchi, David Gunnell, Chris Metcalfe, Matthew J. Spittal and Duleeka Knipe

Int. J. Environ. Res. Public Health 2023, 20(3), 1833; https://doi.org/10.3390/ijerph20031833 - 19 Jan 2023

Cited by 13 | Viewed by 2977

Abstract

Evidence from high-income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (January 2019–December 2021) and data from national records (2016–2021) of [...] Read more.

Evidence from high-income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (January 2019–December 2021) and data from national records (2016–2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models, we defined the lockdown periods as follows: (i) pre-lockdown: 01/01/2019–19/03/2020; (ii) first lockdown: 20/03/2020–27/06/2020; (iii) post-first lockdown: 28/06/2020–11/05/2021; (iv) second lockdown: 12/05/2021–21/06/2021; and (v) post-second lockdown: 22/06/2021–31/12/2021. For suicide, we defined the intervention according to the pandemic period. We found that during lockdown periods, there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed from that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention. Full article

(This article belongs to the Special Issue Suicide in Asia and the Pacific)

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12 pages, 330 KiB

Open AccessArticle

Pathways to Suicide among Police in Rajasthan: Perceptions and Experiences of Police Personnel

by Anne Krayer, Seema Kulhari, Vimal Sharma and Catherine Robinson

Int. J. Environ. Res. Public Health 2023, 20(3), 1812; https://doi.org/10.3390/ijerph20031812 - 18 Jan 2023

Viewed by 2314

Abstract

Background: Evidence regarding the experience and perceptions of police personnel with suicide in South Asia is limited. This study explored the lived experiences and perceptions of suicide among police personnel in an Indian state. The focus was on explanations of and reasons [...] Read more.

Background: Evidence regarding the experience and perceptions of police personnel with suicide in South Asia is limited. This study explored the lived experiences and perceptions of suicide among police personnel in an Indian state. The focus was on explanations of and reasons for suicide. Methods: We conducted 20 qualitative interviews in 2021 with police of different ranks, guided by a topic guide. The reflexive thematic analysis approach was supported by the use of NVivo 12, a qualitative software package. Results: We explore three intersecting key themes around suicide in the police force, including: (1) the stressful police environment; (2) expectations of mental strength; and (3) police image and help-seeking. We discuss the tensions between these themes and how to address the challenges of supporting police personnel. Conclusions: To support and improve police personnel’s mental well-being training and support are needed but also broader changes at the organisational level. These need to take social and historical factors into account. An increased level of suicide and mental health literacy will not only benefit the police force but also the general public, and it would be very timely with recent changes in the Indian mental health and suicide policy context. Full article

(This article belongs to the Special Issue Suicide in Asia and the Pacific)

12 pages, 842 KiB

Open AccessArticle

Understanding Aotearoa New Zealand University Students Intentions to Seek Help If Experiencing Mental Distress: A Comparison of Naturalistic and Interventional Findings

by Andre Mason, Grace Johnstone, Benjamin C. Riordan, Celia Lie, Charlene Rapsey, Gareth J. Treharne, Kyungho Jang, Sunny C. Collings and Damian Scarf

Int. J. Environ. Res. Public Health 2022, 19(23), 15836; https://doi.org/10.3390/ijerph192315836 - 28 Nov 2022

Cited by 2 | Viewed by 2544

Abstract

University students globally are consistently identified as a vulnerable group for mental distress and suicide. Despite this, students report low engagement in help-seeking behaviours. This series of studies aimed to assess barriers to help-seeking for students and the impact of an intervention that [...] Read more.

University students globally are consistently identified as a vulnerable group for mental distress and suicide. Despite this, students report low engagement in help-seeking behaviours. This series of studies aimed to assess barriers to help-seeking for students and the impact of an intervention that sought to increase support-seeking intentions. In Study 1, 373 undergraduate psychology students completed items related to depression, anxiety, suicidal ideation, stigma, and help-seeking intentions. In Study 2, 133 undergraduate psychology students were randomly allocated into one of three intervention groups (control, infographic, video) and completed measures as used in Study 1. Despite experiencing clinically relevant symptoms and recent suicidal ideation, students in Study 1 tended to report low intentionality to seek help, citing perceptions that their distress was not serious enough or a desire to handle their issues independently. In Study 2, an infographic about different support services increased student’s intentions to access support services and reduced their perception that their issues were not serious enough. Overall, Aotearoa New Zealand students endorsed similar barriers to help-seeking as students in other countries. Importantly, we demonstrated that a simple infographic intervention reduced perceptions regarding these common barriers and may increase students’ knowledge about when to seek help. Full article

(This article belongs to the Special Issue Suicide in Asia and the Pacific)

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