Online treatment programmes for suicidal persons

Online treatment programmes extend the reach and effectiveness of psychological interventions for suicide prevention. Such programmes could teach individuals relevant self-management techniques, including emotion regulation or other techniques used in cognitive behaviour therapy (CBT). Advantages such as privacy, low-threshold accessibility, scalability, flexibility, affordability, and standardization increase the appeal of online treatment programmes, but limitations and risks must be considered, including data security breaches, insufficient integration with other care services, lacking efficacy, and potential harm. Many online treatment programmes are broadly CBT-based, but evidence suggests that they might be improved by addressing suicide-specific issues in a more targeted manner. Because online programmes differ in content, interactivity, and other aspects, the safety and efficacy of each programme must be examined separately, but methodologically adequate trials are still rare. Research suggests that safe and effective online treatment programmes for suicide prevention should be developed, and must prove their merit in adequately designed studies.

Family psychoeducation after a suicide attempt

Family can play an important role in supporting a person at-risk of suicide, as well as through treatment and recovery after a suicide attempt. This text provides an overview of the impact a suicide attempt can have on the family and the needs of family carers. Examples of psychosocial interventions for people, mostly adolescents, who have made a suicide attempt and their families are presented along with psychoeducational materials developed for family carers, whose emotional proximity may hinder and/or facilitate engagement with the suicidal person. Although several interventions are promising, further research into the effectiveness of psychoeducational interventions and family involvement after a suicide attempt is warranted.

The International Academy of Suicide Research (IASR)

The International Academy of Suicide Research (IASR) was founded in 1990 with the intention of decreasing suicide mortality by creating a network of the foremost academics in the field of suicidology. Promoting and increasing research on the psychopathological, cognitive and biological characteristics of suicidal individuals and conduct of controlled trials to test suicide prevention methods were goals that sought to improve suicide prevention. Given the small number of such academics in each country, bring the best experts and their findings together, comparing results across nations, cultures and ethnic groups facilitates identifying identify which components of an intervention are effective, and improving strategies for future suicide-preventive programmes. Here, the history, goals and efforts of the IASR are described to guide future international research efforts.

The role of restricting access to potentially lethal medication in suicide prevention

Overdose with medications is a common method of suicide. Reviews of suicide prevention strategies confirmed that restricting access to lethal means is effective in preventing suicides. Nevertheless, there have not been any randomized controlled trials, proving that restriction of the access to toxic medications decreases suicide rates. Existing evidence is based mainly on observational, ecological, and cohort studies. Factors such as better mental health conditions, effective treatment of depression, and improvement in socioeconomic status, may also contribute to decreasing suicide rates. Restrictive measures will have a large effect if the respective method is frequent and lethal. Although there are some concerns about substitution of suicide methods if access to a specific drug is restricted, many studies suggest a life-saving potential. Restrictive measures represent an effective and feasible public health strategy for suicide prevention, particularly in individuals that carry out briefly planned impulsive acts, and in combination with other interventions.

Early detection of risk-taking, self-harming, and suicidal behaviour

This text outlines the role of risk-taking and self-harming behaviours in the development and detection of suicidal behaviour and mental health problems among adolescents. Risk-taking and self-harming behaviours are observable symptoms for underlying problems of emotion regulation, impulse control or interpersonal relationships and are sensitive risk markers for early detection of developmental trajectories of suicidal behaviour and mental health problems. Due to their easy accessibility and their sensitive prediction of mental health problems, risk-taking and self-harming behaviours have been included into programmes screening for adolescents at risk of suicidal behaviour in the general population. The principles and findings of those screening programmes are discussed. Professional screenings are time consuming for participants and create costs for the healthcare system, thus, longitudinal studies are needed to test whether screening programmes are effective in reducing suicidal behaviour among adolescents.

Post-traumatic stress disorder and risk for suicide in combat veterans

Post-traumatic stress disorder (PTSD) is a condition associated with suicide in both military personnel and combat veterans. Most veterans with PTSD, however, are not at risk of suicide. The major factor distinguishing those who attempted or were preoccupied with suicide is persistent severe guilt over behaviour in combat while emotionally out of control. A 12-session short-term, psychodynamic psychotherapy, presented here in this chapter, showed promise of success in dissipating the guilt from combat-related actions in veterans of the war in Vietnam. Preliminary work with combat veterans of the wars in Iraq and Afghanistan indicates it may be equally successful in treating them.

The role of the internet in suicide prevention from the public health perspective

An overview of research on suicide and the internet, as well as the practical applications of online interventions in suicide prevention efforts is given. The text presents how much material about suicide is available online and what are the contents, with a special focus on pro-suicide and harmful online material and communication, and how people at risk of suicide use the internet. The topic of advantages and dangers of suicide-related material available on social media platforms will be covered. The range and effectiveness of online and web-based crisis interventions are discussed, along with support available online for people bereaved by suicide. The text also presents existing efforts on regulation and legislation in relation to suicide-related websites and content.

Prevention of suicide due to charcoal burning

Since the year 2000, suicide by combustion of barbecue charcoal in an enclosed space has become a common method of suicide in many East Asian countries. The spread of charcoal burning suicides was related to the pervasive media glamorization of the method to be a painless, peaceful, and effective way to end one’s life. Popularity of the internet accompanying its contagious effect further imposes challenges in suicide prevention, in particular, in the prevention of charcoal burning suicides. In areas where charcoal burning has already become a common method of suicide, effective strategies include working with the media to moderate the reporting of suicide news and creating barriers in the purchase of charcoal. In other areas where the method is still not widely known, muting the media reporting of this specific method of suicide to eliminate its ‘cognitive availability’ is key to prevent the seeding of charcoal burning suicides.

Religion, more than just protective

Serving as an introduction to the chapters in the ‘Suicide and Religion’ section, we here look beyond the field of suicidology, where emphasis is usually placed on structural indicators and epidemiological/statistical methods. Inspired by anthropological inquiry, suicide is placed firmly among the living and considered a relational phenomenon. Anthropologists have questioned whether suicide is in fact one thing, particularly since the meaning of self and personhood remains so different across the world. Drawing on examples from the chapters ahead, we see how suicide is interpreted and rationalized in teachings of some of the world’s largest religions. We also look closer at religion as a so-called protective factor against suicide much of the research pointing to religious community. By shifting focus towards life and the living, we are presented with the opportunity to observe historical and cultural means of resisting suicide.

Protecting bridges in suicide prevention

In comparison to other methods, suicide by jumping is not as common but nonetheless remains an issue due to its high lethality and accessibility. The majority of suicides by jumping occur from buildings, yet those that are executed from bridges are considered to be more lethal due to a higher fatality rate. One must also take into account that bridges tend to gain more notoriety as suicide hotspots, which can be influenced by media reporting; further highlighting the need for discussion. This text explores the characteristics related to suicide by jumping from a bridge such as psychiatric disorders and socio-demographics, as well as suicide prevention measures including barriers and safety nets, and the role of media reporting.