Development of an online suicide prevention program involving people with lived experience: ideas and challenges

Background Fear of stigmatization, self-stigmatization, and insufficient information can lead to secrecy, reduced help-seeking, lower self-esteem, and lower self-efficacy among people affected by suicidality or suicide. Therefore, we developed an online suicide prevention program aiming to improve knowledge about suicidality and suicide stigma. Methods Inspired by the Australian program The Ripple Effect, a German team comprising people with lived experience of suicide, researchers, and clinicians was established for developing an online suicide prevention program. Therefore, we oriented on guidelines for evidence-based health information, for reporting on suicide, and on dealing with suicidality. The lived experience team discussed and developed concept, structure, and content of the program. This manuscript presents summaries of protocols from 16 team meetings and 3 written text reviews to outline the program development process. A summative evaluation 3 years after program development began was qualitatively analyzed based on thematic analysis. Results Between 2018 und 2021, the lived experience team (n = 10) discussed possibilities of support in suicidal crises, attitudes towards suicide, content, and design of the online program. In a structured process, six members of the lived experience team reviewed the content. Eight persons shared their lived experience of suicide in video reports by focusing on constructive ways of dealing with suicidality or a loss by suicide, conveying hope and encouraging people to continue living. Team members recommended greater public and patient involvement from the application stage, as well as more financial and personnel resources. Conclusions Through contributions to discussions and text reviews, the lived experience team shaped decisions in the program development process. While involving persons with lived experiences of suicide, it is important to consider that suicidality is 1. emotionally challenging, 2. a stigmatized issue, and 3. that the aspect of safety must be a priority. A distinction must be made between the duty of care based on actual risk and inappropriate overprotection. Hereby, transparency, autonomy, and a clear structure appeared to be helpful. For further research, we recommend a structured formative review process of the development of the program. Additionally, we recommend discussing the purpose and the specific design of the evaluation with a lived experience team in advance. Trial registration German Clinical Trial RegisterDRKS00015071 on August 6, 2018.

The influence of religious/spiritual beliefs on Malaysian hospital healthcare workers’ attitudes towards suicide and suicidal patients: a qualitative study

Background There has been mixed findings on whether a healthcare workers’ religious beliefs contribute positively or negatively to their attitudes towards suicidal patients. Aims This study aims to explore qualitatively the influence of religious/spiritual beliefs on healthcare workers’ attitudes towards suicide and suicidal patients in the culturally heterogeneous Malaysian population. Methods Thirty-one healthcare workers from diverse religious backgrounds, professions and medical disciplines were interviewed. Thematic analysis revealed the centrality of religion in determining healthcare workers’ acceptability of suicide, specific religious beliefs that influenced their views on the right-to-die issue, perceptions of the suicidal patient’s religiousness/spirituality, and the aspects and extent of religious relevance in professional philosophy and practice. Results Healthcare workers who could perceive the multifactorial nature of suicide causation had a more empathetic response. There were high levels of paternalism in the care of suicidal patients, involving unsolicited religious/spiritual advice practised as a form of suicide deterrent and social support. Conclusions The formal integration of religious/spiritual practices into the professional care of suicidal patients was indicated.

Development of an online suicide prevention program involving people with lived experience: ideas and challenges

Background Fear of stigmatization, self-stigmatization, and insufficient information can lead to secrecy, reduced help-seeking, lower self-esteem, and lower self-efficacy among people affected by suicidality or suicide. Therefore, we developed an online suicide prevention program aiming to improve knowledge about suicidality and suicide stigma. Methods Inspired by the Australian program The Ripple Effect, a German team comprising people with lived suicide experience, researchers, and clinicians was established for developing an online suicide prevention program. Therefore, we oriented on guidelines for evidence-based health information, for reporting on suicide, and on dealing with suicidality. The lived experience team discussed and developed concept, structure, and content of the program. This manuscript presents summaries of protocols from 16 team meetings and 3 written text reviews to outline the program development process. A summative evaluation 3 years after program development began is qualitatively analyzed based on thematic analysis. Results Between 2018 und 2021, the lived experience team (n = 10) discussed possibilities of support in suicidal crises, attitudes towards suicide, content, and design of the online program. In a structured process, six members of the lived experience team reviewed the content. Eight persons shared their lived suicide experience in video reports by focusing on constructive ways of dealing with suicidality or a loss by suicide, conveying hope and encouraged people to continue living. Team members recommended greater public and patient involvement from the application stage, as well as more financial and personnel resources. Conclusions Through contributions to discussions and text reviews, the lived experience team shaped decisions in the program development process. While involving persons with lived suicide experience, it is important to consider that suicidality is 1. emotionally challenging, 2. a stigmatized issue, and 3. that the aspect of safety must be a priority. A distinction must be made between the duty of care based on actual risk and inappropriate overprotection. Hereby, transparency, autonomy, and a clear structure appeared to be helpful. For further research, we recommend a structured formative review process of the development of the program. We recommend discussing the purpose and the specific design of the evaluation with a lived experience team in advance. Trial registration German Clinical Trial Register DRKS00015071 on August 6, 2018.

Attitudes Towards Suicide among People with Eating Disorders

Clients of social workers have elevated suicide risks. One of those types of clients are people with eating disorders. Suicidality is associated with attitudes towards suicide. Although the suicidality of people with eating disorders is well-studied, their attitudes towards suicide have received less attention. The object of this research is to study the attitudes among people with eating disorders – 126 participants took place in this research: 63 people with eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, other eating disorders) and 63 people without eating disorders. All the participants with eating disorders at the time of the research were receiving treatment at the Center for Eating Disorders (VšĮ Vilnius Mental Health center). The majority of participants were women (92%), with an average age of 25 years. All the respondents filled in an Attitudes towards suicide questionnaire (ATTS) and its supplement. The results showed that participants with eating disorders perceived suicide as less predictable and associated it with loneliness more than participants without eating disorders. Attitudes of people with anorexia nervosa and with bulimia nervosa towards suicide did not differ significantly. Participants with anorexia nervosa perceived suicide as less predictable, showed more nonintrusive attitudes towards suicide and associated it with loneliness more than participants without eating disorders. Attitudes towards suicide among people with bulimia nervosa and people without eating disorders did not differ significantly. The results could be explained by considering the characteristics of people with eating disorders and the methodology of this research. Recommendations for social work practice were formed based on the findings.

The Shinto religion and suicide in Japan

The Shinto religion profoundly influences many Japanese people. It is their emotional mainstay, although it has neither common commandments nor scriptures. According to Shinto, human beings are part of nature and can live only because nature is the parent. Mankind should live in the ‘way of the gods’. The worship of ancestors is an important value in Shinto. The Shinto attitude towards suicide is somewhat ambivalent. Shinto believes that humans return to nature after death, suicide does not constitute an exception, and suicide as a sacrificial act is condoned. On the other hand, believing that life is given by nature and ancestors implies that suicide is wrong. The increasing number of suicides during recent years, mainly for socioeconomic reasons, has deeply affected the Japanese society and its attitudes towards suicide. This has resulted in many suicide prevention activities in which religion can play an important role.

Universal suicide prevention in schools

Schools are one of the most important settings for health promotion and preventive interventions for young people and therefore became one of the main targets of youth suicide prevention programmes. School-based suicide prevention interventions are presented here according to the Universal/Selective/Indicated model. Evidence of the effectiveness of the different programmes is discussed. Universal interventions proved to be the most effective. Particularly, Signs of Suicide (SOS) and Youth Aware of Mental health (YAM) programme showed to significantly reduce suicidal ideation and behaviours. Gatekeeper training, especially QPR (Question, Persuade, and Refer), are also widely implemented but their efficacy was mostly evaluated as changes in knowledge and attitudes towards suicide. Screening programmes do not have iatrogenic effects and are effective in identifying at-risk students who otherwise would not be recognized, however their level of sensitivity and specificity require further improvements. Some systematic reviews suggested that a combination of programmes may be most effective.

Suicide prevention by education and the moulding of attitudes

In this chapter, the challenge of influencing the attitudes towards suicide prevention in key individuals or gatekeepers, in mental health and suicide prevention, is addressed. Based on experiences from several training programmes, the importance of a psychological perspective on suicidality is seen as relevant even in population-based research and prevention. One focus in the discussion is on the distinction between having an immediate impact on conscious attitudes and the more difficult challenge of influencing less conscious, individual, and cultural ambivalent attitudes to suicide prevention. In light of the universal stigma of and taboo against the topic of suicide, the ability of prevention specialists to withhold judgement and reflect on their own emotional responses to self-destructiveness is considered as an aspect of a scientific attitude. In addition, an anthropological elucidation of mental ill-health and suicide is called for as a supplement to the biopsychosocial, stress-vulnerability paradigm in suicide-preventive training programmes.