Suicide-Related Internet Use Among Suicidal Young People in the UK: Characteristics of Users, Effects of Use, and Barriers to Offline Help-Seeking

The study replicates earlier research using a UK sample to examine differences between suicidal people who go online for suicide-related reasons and suicidal people who do not, perceived effects of suicide-related Internet use, and perceived barriers to offline help-seeking. A total of 72 UK citizens (18–24 years old) who had contemplated killing themselves or deliberately harmed themselves with the intention of dying within the past 12 months participated in an anonymous online survey. Results indicate that suicidal young people who use the Internet for suicide-related purposes are a high-risk group characterized by higher levels of social anxiety. The main purposes of suicide-related Internet use were to connect with others and seek information. Both positive and negative effects were found

Declines in the Lethality of Suicide Attempts Explain the Decline in Suicide Deaths in Australia

Background: To investigate the epidemiology of a steep decrease in the incidence of suicide deaths in Australia. Methods: National data on suicide deaths and deliberate self-harm for the period 1994–2007 were obtained from the Australian Institute of Health and Welfare. We calculated attempt and death rates for five major methods and the lethality of these methods. Negative binomial regression was used to estimate the size and significance of method-specific time-trends in attempts and lethality. Results: Hanging, motor vehicle exhaust and firearms were the most lethal methods, and together accounted for 72% of all deaths. The lethality of motor vehicle exhaust attempts decreased sharply (RR = 0.94 per year, 95% CI 0.93–0.95) while the motor vehicle exhaust attempt rate changed little; this combination of motor vehicle exhaust trends explained nearly half of the overall decline in suicide deaths. Hanging lethality also decreased sharply (RR = 0.96 per year, 95% CI 0.956–0.965) but large increases in hanging attempts negated the effect on death rates. Firearm lethality changed little while attempts decreased. Conclusion: Declines in the lethality of suicide attempts–especially attempts by motor vehicle exhaust and hanging–explain the remarkable decline in deaths by suicide in Australia since 1997

Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study

BACKGROUND: Workforce participation is a key feature of public mental health and social inclusion policies across the globe, and often a therapeutic goal in treatment settings. Understanding the reciprocal relationship between participation and mental health has been limited by inadequate research methods. This is the first study to simultaneously examine and contrast the relative effects of unemployment on mental health and mental health on employment status in a single general population sample. METHOD: Data were from working-age respondents (20 to 55 years at baseline) who completed nine waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (N=7176). Cross-lagged path analyses were used to test the lagged and concurrent associations between unemployment and mental health over time, adjusting for sociodemographic characteristics. RESULTS: Mental health was shown to be both a consequence of and risk factor for unemployment. Thus, the poorer mental health observed amongst people who are not working is attributable to both the impact of unemployment and existing mental health problems. While the strength of these two effects was similar for women, the results for men suggested that the effect of unemployment on subsequent mental health was weaker than the effect of mental health on subsequent risk of unemployment. CONCLUSION: Disentangling the reciprocal links between mental health and workforce participation is central to the development and success of clinical goals and health and social policies that aim to promote either aspect. This study demonstrates that both effects are important and supports concurrent responses to prevent a cycle of disadvantage and entrenched social exclusion.SCO and LSL were funded by the Australian National University and fellowships from the Australian National Health and Medical Research Council. PB and JP were funded by fellowships from the Australian National Health and Medical Research Council. MK was funded by a fellowship from the Australian Research Council

How best to provide help to bereaved adolescents:a Delphi consensus study

BACKGROUND: Many adolescents struggle with their grief and mental health issues after the death of a close person, such as a family member or a friend. Given the potentially devastating impact of the loss on the adolescent and their family, professional help can be warranted. However, little is known about how to best help these adolescents. This study aimed to address this gap by determining what help professionals (i.e., counselors) should provide to bereaved adolescents. METHODS: The Delphi method was used to achieve consensus regarding the importance of statements that describe actions a helping professional can take to help a bereaved adolescent. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing interview data from a recent related research study with bereaved adolescents, parents and counselors. An expert panel (N = 49) comprising 16 adolescents, 14 parents and 19 helping professionals, rated each statement. Statements that were endorsed by at least 80% of panellists were considered consensus recommendations. RESULTS: Panellists endorsed 130 out of 190 statements as appropriate actions. These included help for a bereaved adolescent being offered on an ongoing basis, with support to be provided flexibly to meet individual adolescent needs and to acknowledge the agency of the adolescent. Support after a loss by suicide should be tailored to address specific suicide-related issues. Parents of bereaved adolescents should also be offered support so that they are better equipped to help their bereaved adolescent. CONCLUSIONS: This study identified consensus recommendations on how a helping professional might best help bereaved adolescents. It is hoped that these recommendations will guide helping professionals and enhance adolescent grief interventions

Routine measurement of outcomes in Australia's public sector mental health services

OBJECTIVE: This paper describes the Australian experience to date with a national 'roll out' of routine outcome measurement in public sector mental health services. METHODS: Consultations were held with 123 stakeholders representing a range of roles. RESULTS: Australia has made an impressive start to nationally implementing routine outcome measurement in mental health services, although it still has a long way to go. All States/Territories have established data collection systems, although some are more streamlined than others. Significant numbers of clinicians and managers have been trained in the use of routine outcome measures, and thought is now being given to ongoing training strategies. Outcome measurement is now occurring 'on the ground'; all States/Territories will be reporting data for 2003–04, and a number have been doing so for several years. Having said this, there is considerable variability regarding data coverage, completeness and compliance. Some States/Territories have gone to considerable lengths to 'embed' outcome measurement in day-to-day practice. To date, reporting of outcome data has largely been limited to reports profiling individual consumers and/or aggregate reports that focus on compliance and data quality issues, although a few States/Territories have begun to turn their attention to producing aggregate reports of consumers by clinician, team or service. CONCLUSION: Routine outcome measurement is possible if it is supported by a co-ordinated, strategic approach and strong leadership, and there is commitment from clinicians and managers. The Australian experience can provide lessons for other countries

Understanding service demand for mental health among Australians aged 16 to 64 years according to their possible need for treatment

Background: To inform decisions about mental health resource allocation, planners require reliable estimates of people who report service demand (i.e. people who use or want mental health services) according to their level of possible need. Methods: Using data on 6915 adults aged 16-64 years in Australia's 2007 National Survey of Mental Health and Wellbeing, we examined past-year service demand among respondents grouped into four levels of possible need: (a) 12-month mental disorder; (b) lifetime but no 12-month mental disorder; (c) any other indicator of possible need (12-month symptoms or reaction to stressful event, or lifetime hospitalisation); (d) no indicator of possible need. Multivariate logistic regression analyses examined correlates of service demand, separately for respondents in each of levels 1-3. Results: Sixteen per cent of Australian adults reported service demand, of whom one-third did not meet criteria for a 12-month mental disorder (equivalent to 5.7% of the adult population). Treatment patterns tended to follow a gradient defined by level of possible need. For example, service users with a 12-month disorder received, on average, 1.6-3.9 times more consultations than their counterparts in other levels of possible need, and had 1.9-2.2 times higher rates of psychologist consultation. Service users with a lifetime but not 12-month disorder or any other indicator of need consumed a similar average number of services to people with mild 12-month mental disorders, but received relatively fewer services involving the mental health sector. Service demand was associated with increased suicidality and psychological distress in all levels of possible need examined, and with poorer clinical and functional status for those with 12-month or lifetime disorders. Conclusions: Many Australians reporting service demand do not meet criteria for a current mental disorder, but may require services to maintain recovery following a past episode or because they are experiencing symptoms and significant psychological distress

Media Roles in Suicide Prevention: A Systematic Review

The aim of the current systematic review was to monitor and provide an overview of the research performed about the roles of media in suicide prevention in order to find out possible effects media reporting on suicidal behaviours might have on actual suicidality (completed suicides, attempted suicides, suicidal ideation). The systematic review was performed following the principles of the PRISMA statement and includes 56 articles. Most of the studies support the idea that media reporting and suicidality are associated. However, there is a risk of reporting bias. More research is available about how irresponsible media reports can provoke suicidal behaviours (the ‘Werther effect’) and less about protective effect media can have (the ‘Papageno effect’). Strong modelling effect of media coverage on suicide is based on age and gender. Media reports are not representative of official suicide data and tend to exaggerate sensational suicides, for example dramatic and highly lethal suicide methods, which are rare in real life. Future studies have to encounter the challenges the global medium Internet will offer in terms of research methods, as it is difficult to define the circulation of news in the Internet either spatially or in time. However, online media can provide valuable innovative qualitative research material