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Introduction: Police-officers are in a strategic position of providing the first immediate response to a crisis as mental health frontliners. Objectives: In this nation-wide cross-sectional study, we explored knowledge and attitudes towards suicide in the local police force, a crucial first step in the design and implementation of effective suicide prevention programmes. Methods: An online, anonymous questionnaire was distributed to all local police-officers (n=2600). It contained questions about their demographics and their experience with suicide while on duty, along with 34 statements from the validated tool Attitudes Towards Suicide (ATTS) (Renberg & Jacobsson. Suicide Life Threat Behav. 2003; 33 52-64), scored on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree). Results: The sub-scale " Suicide as a right " was positively correlated with " Tabooing " (r (201) =.25, p=<.001), " Normal-common " (r (201) =.29, p=<.001), and " Resignation " (r (201) =.47, p=<.001), but negatively correlated with " Incomprehensibility " (r (201) = -.26, p=<.001), and " Preparedness to Prevent " (r (201) = -.19, p=<.001), meaning such individuals had a more permissive attitude towards suicide. On the other hand, the subscale Preventability was found to be positively correlated with Incomprehensibility (r (201) =.21, p=<.001) and Preparedness to Prevent (r (201) =.30, p=<.001). Females scored higher in the sub-scale Non-communication (M=3.40, 95% CI [3.29, 3.51]) while males scored higher in Preventability (M=3.35, 95% CI [3.27, 3.44]). The higher the educational status of police-officers, the more they adopt a pro-prevention attitude to suicide (M=3.67, 95% CI [3.44, 3.89]) and the more likely they are to appreciate that suicidal thoughts and behaviour can be common (M=3.40, 95% CI [3.20, 3.60]). Participants with a mixed/different composition at home (M=4.05, 95% CI [3.86, 4.24]) and/or have experienced only between 0 to 2 situations related to suicide in the past one year alone (M=4.05, 95% CI [3.94, 4.16]), were the most likely to feel prepared to prevent suicide. Conclusions: This study brings out different attitudes police-officers hold towards different aspects of suicide, influenced by their gender, educational background, personal life at home and total exposure to suicide during their career. Training programmes can help improve their knowledge and attitudes towards suicide, leading to a more positive behavioural response to individuals in crisis and create a safer environment. Malta, through an EU-funded programme, is currently investing its resources on drafting a national suicide prevention strategy, and such educational opportunities for our frontliners will ensure we have the right tools in screening, identifying, treating, and saving more lives. Abbreviations: M: Mean score; CI: Confidence Interval Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Background: Despite global concerns of an opioid epidemic, there is no systematic literature review on how frequently these drugs are used in nursing home (NH) populations, including those living with dementia. Objective: This systematic review aims to describe the prevalence and incidence of opioid use in NHs. A secondary objective is to describe the use of these drugs in a subset of NH residents, namely among persons living with dementia. Methods: A systematic literature review was carried out using MEDLINE and Scopus (PROSPERO registration number CRD42021254210). Screening of title and abstract was carried out by 2 persons independently for studies published between January 1, 2011 and May 19, 2021. The main outcomes were annual prevalence, period prevalence, and duration of opioid use. Results: From a total of 178 identified studies, 29 were considered eligible for inclusion. The annual prevalence of any opioid use among all NH residents without any selection criteria ranged from 6.3% to 50% with a median annual prevalence of 22.9% (Q25-Q75: 19.5%-30.2%), based on 17 studies. Five studies measured the annual prevalence in NH residents living with dementia, finding that this ranged from 10% to 39.6%. Conclusions: More evidence is needed quantifying opioid use in NH, especially among persons living with dementia. Given that opioid use in NH is still a problem, implementation of a pain management protocol in NH or nationally would help improve clinical outcomes., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C.B. has received honoraria and grant funding from Acadia Pharmaceuticals, Lundbeck, Takeda, and Axovant pharmaceutical companies, not related to this study. C.B. leads the Alzheimer’s disease psychosis (ADP) investigators group and has received honoraria from Lundbeck, Lilly, Otsuka, and Orion pharmaceutical companies, not related to this study. The other authors have no potential conflicts of interests to declare., (© The Author(s) 2023.)