Demographic risk factors for suicide among youths in the Netherlands

In 2000 to 2016 the highest number of suicides among Dutch youths under 20 in any given year was 58 in 2013. In 2017 this number increased to 81 youth suicides. To get more insight in what types of youths died by suicide, particularly in recent years (2013-2017) we looked at micro-data of Statistics Netherlands and counted suicides among youths till 23, split out along gender, age, regions, immigration background and place in household and compared this to the general population of youths in the Netherlands. We also compared the demographics of young suicide victims to those of suicide victims among the population as a whole. We found higher suicide rates among male youths, older youths, those of Dutch descent and youths living alone. These differences were generally smaller than in the population as a whole. There were also substantial geographical differences between provinces and healthcare regions. The method of suicide is different in youth compared to the population as a whole: relatively more youth suicides by jumping or lying in front of a moving object and relatively less youth suicides by autointoxication or drowning, whereas the most frequent method of suicide among both groups is hanging or suffocation

Guiding principles for the implementation of a standardized psychological autopsy to understand and prevent suicide: a stakeholder analysis

BackgroundAround 700,000 people die by suicide each year. While the global number of suicides declined over the last decade, the rates remained unchanged in the Netherlands. With this study, we aimed to provide guiding principles for the implementation of a national standardized psychological autopsy to better understand and prevent suicide, by exploring stakeholder perceptions and needs, and barriers to implementation.MethodsWe interviewed 47 representative stakeholders from various fields (e.g., mental healthcare professionals, policy advisors, researchers). A semi structured interview design was used, based on the RE-AIM and Consolidated Framework for Implementation Research (CFIR) theoretical frameworks.ResultsThemes relating to stakeholder perceptions and needs for a standardized psychological autopsy included valorization, accountability, integrability and the needs of the bereaved. Stakeholders believed that participation in a psychological autopsy can help bereaved in their process of grief but noted that evidence to frame the psychological autopsy as postvention is insufficient. The primary focal point should accordingly be to better understand and prevent suicide. Several key limitations of the proposed psychological autopsy approach were detailed, both methodological and implementational.ConclusionThe stakeholder analysis delineates guiding principles for implementation. Stakeholders believe that a standardized psychological autopsy has merit, provided that key considerations, including valorization and accountability, are integrated in its design. Routine evaluation should be ensured. The findings may guide policy makers and researchers in their endeavors to support a learning, community-based approach for suicide prevention based on a standardized psychological autopsy

Additional value of peer informants in psychological autopsy studies of youth suicides

In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned

Content-based recommender support system for counselors in a suicide prevention chat helpline: Design and evaluation study

Background: The working environment of a suicide prevention helpline requires high emotional and cognitive awareness from chat counselors. A shared opinion among counselors is that as a chat conversation becomes more difficult, it takes more effort and a longer amount of time to compose a response, which, in turn, can lead to writer's block. Objective: This study evaluates and then designs supportive technology to determine if a support system that provides inspiration can help counselors resolve writer's block when they encounter difficult situations in chats with help-seekers. Methods: A content-based recommender system with sentence embedding was used to search a chat corpus for similar chat situations. The system showed a counselor the most similar parts of former chat conversations so that the counselor would be able to use approaches previously taken by their colleagues as inspiration. In a within-subject experiment, counselors' chat replies when confronted with a difficult situation were analyzed to determine if experts could see a noticeable difference in chat replies that were obtained in 3 conditions: (1) with the help of the support system, (2) with written advice from a senior counselor, or (3) when receiving no help. In addition, the system's utility and usability were measured, and the validity of the algorithm was examined. Results: A total of 24 counselors used a prototype of the support system; the results showed that, by reading chat replies, experts were able to significantly predict if counselors had received help from the support system or from a senior counselor (P=.004). Counselors scored the information they received from a senior counselor (M=1.46, SD 1.91) as significantly more helpful than the information received from the support system or when no help was given at all (M=-0.21, SD 2.26). Finally, compared with randomly selected former chat conversations, counselors rated the ones identified by the content-based recommendation system as significantly more similar to their current chats (β=.30, P<.001). Conclusions: Support given to counselors influenced how they responded in difficult conversations. However, the higher utility scores given for the advice from senior counselors seem to indicate that specific actionable instructions are preferred. We expect that these findings will be beneficial for developing a system that can use similar chat situations to generate advice in a descriptive style, hence helping counselors through writer's block

Who didn't consult the doctor? Understanding sociodemographic factors in relation to health care uptake before suicide

Objective: This study aimed to establish differences between suicide decedents and a reference population across various health care settings.Methods: This population-wide registration study combined death statistics, sociodemographic data and health care data from Statistics Netherlands. From 2010 to 2016, 12,015 suicide cases and a random reference group of 132,504 were included and assigned to one of the three health care settings; mental health (MH) care, primary care or no care. Logistic regression analyses were performed to determine differences in suicide risk factors across settings.Results: In the 1–2 year period before suicide, 52% of the suicide decedents received MH care, 41% received GP care only and 7% received neither. Although sociodemographic factors showed significant differences across settings, the suicide risk profiles were not profoundly distinctive. A decreasing trend in suicide risk across health care settings became apparent for male gender, income level and being in a one-person or one-parent household, whereas for other factors (middle and older age, non-Western migration background, couples without children and people living in more sparsely populated areas), risk of suicide increased when health care setting became more specialized.Limitations: Because of the data structure, 18 months of suicide decedents’ health care use were compared with two years health care use of the reference group, which likely led to an underestimation of the reported differences.Conclusion: Although there are differences between suicide decedents and a reference group across health care settings, these are not sufficiently distinctive to advocat

Gender differences in suicide-related communication of young suicide victims

OBJECTIVES: There is limited insight into gender differences in suicide-related communication (SRC) in youths. SRC is defined as “the act of conveying one’s own suicide ideation, intent or behaviours to another person”. Increasing our understanding of SRC in youths will enable us to recognize and specify needs of female versus male youths. The current study explores SRC in a sample of Dutch suicide victims aged under 20 and examines gender differences. METHODS: Interview data from a psychological autopsy study of 35 youths who died by suicide in the Netherlands in 2017 were analysed. Qualitative analyses were performed to examine explicit SRC throughout the youths’ lives and implicit SRC during the last months prior to suicide. We employed the Constant Comparative Method to explore patterns in the debut, form, frequency, medium, content, type of recipient, and SRC in the last months prior to suicide death. RESULTS: We identified commonalities in the SRC of youths, including the content of suicide notes and an emphasis on suicide method and preparation in the last months. Girls, however, had an earlier debut of SRC, a higher frequency of explicit SRC, and more often directed SRC towards varied types of recipients compared to boys. Moreover, SRC of girls seemed focused on coping and achieving support from others more than SRC of boys. The SRC of boys in comparison to girls was often ambiguous or diluted by “humorous” connotations. CONCLUSION: Unique patterns in SRC of boys and girls posed corresponding challenges for next of kin to interpret communications and respond adequately to SRC. The early debut of girls’ SRC highlights the importance of early screening and prevention efforts in girls, while the late debut and ambiguity in boys’ SRC implores professionals and next of kin to encourage young males to be unequivocal about suicide ideation or intent

Detecting changes in help seeker conversations on a suicide prevention helpline during the COVID− 19 pandemic: in-depth analysis using encoder representations from transformers

Background: Preventatives measures to combat the spread of COVID− 19 have introduced social isolation, loneliness and financial stress. This study aims to identify whether the COVID-19 pandemic is related to changes in suicide-related problems for help seekers on a suicide prevention helpline. Methods: A retrospective cohort study was conducted using chat data from a suicide prevention helpline in the Netherlands. The natural language processing method BERTopic was used to detect common topics in messages from December 1, 2019 until June 1, 2020 (N = 8589). Relative topic occurrence was compared before and during the lock down starting on March 23, 2020. The observed changes in topic usage were likewise analyzed for male and female, younger and older help seekers and help seekers living alone. Results: The topic of the COVID-19 pandemic saw an 808% increase in relative occurrence after the lockdown. Furthermore, the results show that help seeker increased mention of thanking the counsellor (+ 15%), and male and young help seekers were grateful for the conversation (+ 45% and + 32% respectively). Coping methods such as watching TV (− 21%) or listening to music (− 15%) saw a decreased mention. Plans for suicide (− 9%) and plans for suicide at a specific location (− 15%) also saw a decreased mention. However, plans for suicide were mentioned more frequently by help seekers over 30 years old (+ 11%) or who live alone and (+ 52%). Furthermore, male help seekers talked about contact with emergency care (+ 43%) and panic and anxiety (+ 24%) more often. Negative emotions (+ 22%) and lack of self-confidence (+ 15%) were mentioned more often by help seekers under 30, and help seekers over 30 saw an increased mention of substance abuse (+ 9%). Conclusion: While mentions of distraction, social interaction and plans for suicide decreased, expressions of gratefulness for the helpline increased, highlighting the importance of contact to help seekers during the lockdown. Help seekers under 30, male or who live alone, showed changes that negatively related to suicidality and should be monitored closely

A multi-method psychological autopsy study on youth suicides in the Netherlands in 2017:Feasibility, main outcomes, and recommendations

Objectives: In the Netherlands, there was a sharp increase in the number of suicides among 10- to 19-year-olds in 2017. A multi-method psychological autopsy study (PA) was conducted to assess feasibility, identify related factors, and study the interplay of these factors to inform suicide prevention strategies. Methods: Coroners identified youth suicides in 2017 in their records and then general practitioners (GPs) contacted the parents of these youths. Over a period of 7 months, 66 qualitative interviews were held with the parents, peers, and teachers, providing information on precipitating factors and five topics involving 35 cases (17 boys and 18 girls, mean age 17 years). Furthermore, 43 parents and care professionals filled in questionnaires to examine risk and care-related factors. Qualitative and quantitative analyses were performed. Results: Although registration problems faced by coroners and resistance to contacting bereaved families by GPs hampered the recruitment, most parents highly appreciated being interviewed. Several adverse childhood experiences played a role at an individual level, such as (cyber) bullying, parental divorce, sexual abuse, as well as complex mental disorders, and previous suicide attempts. Two specific patterns stood out: (1) girls characterized by insecurity and a perfectionist attitude, who developed psychopathology and dropped out of school, and (2) boys with a developmental disorder, such as autism, who were transferred to special needs education and therefore felt rejected. In addition, adolescents with complex problems had difficulty finding appropriate formal care. Regarding potential new trends, contagion effects of social media use in a clinical setting and internet use for searching lethal methods were found. Conclusion: This first national PA study showed that, as expected, a variety of mostly complex clusters of problems played a role in youth suicides. An infrastructure is needed to continuously monitor, evaluate, and support families after each youth suicide and thereby improve prevention strategies

The effect of local Suicide Prevention Action Networks (SUPRANET) on stigma, taboo and attitudes towards professional help-seeking: an exposure–response analysis

Purpose: In 2017, the European Alliance against Depression (EAAD) programme was introduced in the Netherlands through the creation of six local Suicide Prevention Action Networks (SUPRANET Community). This programme consists of interventions on four levels: (1) a public awareness campaign, (2) training local gatekeepers, (3) targeting high-risk persons in the community and (4) training of primary care professionals. This study aims to gain insight into the effectiveness of the SUPRANET programme on attitudinal changes in the general public by studying the exposure–response relationship. Methods: A repeated cross-sectional design, using general population surveys to measure key variables over time. The surveys were conducted in the six intervention regions (N = 2586) and in the Netherlands as a whole as a control region (N = 4187) and include questions on socio-demographic variables, brand awareness of the Dutch helpline, perceived taboo on suicide, attitudes towards depression and help-seeking. To examine the exposure–response relationship, regions were diff

The impact of a suicide prevention awareness campaign on stigma, taboo and attitudes towards professional help-seeking

Background: In 2017, the European Alliance against Depression (EAAD) was introduced in The Netherlands through the creation of six Suicide Prevention Action Networks (SUPRANET Community). The intervention was launched with a national suicide prevention awareness campaign. This campaign aims to encourage the general public to talk about suicide. This study aimed to gain insight into the effectiveness of the campaign in achieving attitudinal change in the general public, as stigmas related to mental health disorders and -services are an important reason for insufficient help-seeking. Methods: A repeated cross-section design, using general population surveys (N = 6,773) to measure key variables over time. The survey includes questions on socio-demographic variables, campaign visibility, brand awareness of the Dutch helpline, perceived taboo on suicide, attitudes towards depression and help-seeking. Results: The public awareness campaign was predominantly visible among the younger generation. Respondents who indicated having seen the public awareness campaign showed more openness towards seeking professional help and were considerably more likely to be familiar with the Dutch helpline than those who reported not having seen the campaign. Campaign awareness also seemed to relate to a higher perceived taboo on suicide and a lower estimation o