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The abuse of methylenedioxymethamphetamine (MDMA) during pregnancy is of concern. MDMA treatment of rats during a period of brain growth analogous to late human gestation leads to neurochemical and behavioral changes. MDMA from postnatal day (P)11–20 in rats produces reductions in serotonin and deficits in spatial and route-based navigation. In this experiment we examined the impact of MDMA from P11 to P20 (20 mg/kg twice daily, 8 h apart) on neuronal architecture. Golgi impregnated sections showed significant changes. In the nucleus accumbens, the dendrites were shorter with fewer spines, whereas in the dentate gyrus the dendritic length was decreased but with more spines, and for the entorhinal cortex, reductions in basilar and apical dendritic lengths in MDMA animals compared with saline animals were seen. The data show that neuronal cytoarchitectural changes are long-lasting following developmental MDMA exposure and are in regions consistent with the learning and memory deficits observed in such animals.

Background: The involvement of people with lived experience (LEX) workers in the development, design, and delivery of integrated health services seeks to improve service user engagement and health outcomes and reduce healthcare gaps. Yet, LEX workers report feeling undervalued and having limited influence on service delivery. There is a need for systematic improvements in how LEX workforces are engaged and supported to ensure the LEX workforce can fully contribute to integrated systems of care., Objective: This study aimed to operationalize the Consolidated Framework for Implementation Research (CFIR) using a rigorous scoping review methodology and co-creation process, so it could be used by health services seeking to build and strengthen their LEX workforce., Search Strategy: A systematic literature search of four databases was undertaken to identify peer-reviewed studies published between 2016 and 2022 providing evidence of the inclusion of LEX workers in direct health service provision., Data Extraction and Synthesis: A descriptive-analytical method was used to map current evidence of LEX workers onto the CFIR. Then, co-creation sessions with LEX workers (n = 4) and their counterparts-nonpeer workers (n = 2)-further clarified the structural policies and strategies that allow people with LEX to actively participate in the provision and enhancement of integrated health service delivery., Main Results: Essential components underpinning the successful integration of LEX roles included: the capacity to engage in a co-creation process with individuals with LEX before the implementation of the role or intervention; and enhanced representation of LEX across organizational structures., Discussion and Conclusion: The adapted CFIR for LEX workers (CFIR-LEX) that was developed as a result of this work clarifies contextual components that support the successful integration of LEX roles into the development, design, and delivery of integrated health services. Further work must be done to operationalize the framework in a local context and to better understand the ongoing application of the framework in a health setting., Patient or Public Contribution: People with LEX were involved in the operationalization of the CFIR, including contributing their expertise to the domain adaptations that were relevant to the LEX workforce., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

The objective of this review is to use a decolonised, Indigenist lens to understand the definition of solastalgia from an Aboriginal perspective, as a potential emotional response experienced by Aboriginal communities impacted by increasingly frequent natural disasters, such as bushfires. Initial search results revealed a lack of literature referencing solastalgia in an Aboriginal-specific context. Indigenist research methodologies such as Heuristic inquiry and Aboriginal Participatory Action Research (APAR) contributed to the identification of alternative terminologies, which led to the majority of the included publications referring to solastalgia-related concepts, with one included publication mentioning solastalgia specifically. These methods were consequently used to synthesize data, confirm results and contribute to final discussions. Lastly, our results determined that at this stage there is insufficient evidence to conclusively suggest that Aboriginal Peoples in a general sense, experience solastalgia. Acknowledging the ethical dilemma and potential harm of generalising personal philosophies and experiences based on Culture. Thereby, signify the need for further research in this space and in particular, from a decolonised, Indigenist perspective., Preface: In the context of this review, we as co-authors are mindful of and respect the tensions or politics associated with proclaiming or discussing the identities of Australia's First Peoples. Therefore, in the context of this review, the often preferred term Aboriginal refers to the traditional owners of Australia. Where possible, traditional place/tribe names are written to acknowledge the ownership and origins of the information referenced within this review. Furthermore, we wish to acknowledge the storeys and traditional knowledge shared by the authors of the studies referenced within this review. These words of Country and Kin have contributed to the development and conceptualisation of this literature review, and we wish to pay our respects and appreciation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Upward, Usher, Saunders and Maple.)

Background: Suicide is more prevalent among disadvantaged, discriminated, and marginalised people with the majority of global suicide deaths occurring in the low-and middle-income countries (LMICs). This can be attributed to sociocultural contexts and exacerbated by access to limited resources and services that can assist with early identification, treatment, and support. Accurate information on the personal experiences of suicide is lacking, as many LMICs legislate that suicide is illegal., Methods: This study aims to review the qualitative literature to explore the experiences of suicide in LMICs from the first-person perspective. Following the PRISMA-2020 guidelines, the search for qualitative literature published between January 2010 and December 2021 was undertaken. A total number of 110 qualitative articles from 2569 primary studies met the inclusion criteria. Included records were appraised, extracted, and synthesised., Results: The results provide lived experience insight into suicide from those living in LMICs, including understanding variations of the causes of suicides, the impacts on others exposed to suicide, existing support systems, and prevention measures to reduce suicide among LMICs. The study offers a contemporaryunderstanding of how people in LMIC experience suicide., Conclusions: The findings and recommendations are derived from the similarities and differences within the existing knowledge base that is dominated by evidence from high-income countries. Timely suggestions for future researchers, stakeholders, and policymakers are provided., (© 2023. The Author(s).)

Background: Potential solutions to bridging the research practice gap include collaborative frameworks and models. Yet there is little evidence demonstrating their application in practice. In addressing this knowledge gap, this in-depth case study explored how the co-creation of new knowledge framework and its four collaborative processes (co-ideation, co-design, co-implementation, and co-evaluation) are utilised to support people who had attempted suicide through an Australian psychoeducational program known as Eclipse., Methods: Using a case study design and a thematic analysis methodology, multiple sources of qualitative data (collaborative group discussion, personal communications) were analysed inductively and deductively to examine the implementation of co-creation and explore the perspectives of researchers and stakeholders about co-creation and collaborative relationships., Results: Three broad themes were identified: (1) understanding the language and practice of co-creation, (2) perception of trust formation, and (3) the value of co-creation opportunities. Ultimately, implementing co-creation with or between researchers, industry and people with lived experience requires trust, reciprocity, good fortune, and good management. While implementing co-creation, the co-creation framework was revised to include additional elements identified as missing from the initially proposed framework., Conclusion: Co-creation of new knowledge poses many challenges to researchers and stakeholders, particularly regarding its "messiness" and non-linear approach to implementation and evaluation. However, as this case study demonstrates, it has the potential to become an alternative framework of best practice for public health interventions in third sector organisations, most notably as it eliminates the often-lengthy gap reported between research evidence and translation into practice. The research highlights the need for co-creation to further study its effectiveness in integrating research and service delivery to generate new knowledge. This may lead to a cultural and behavioural change in the service provider's approach to research, offering better outcomes for providers, clients, policymakers, universities, and funders., (© 2022. The Author(s).)

Background: In Australia, the collaborative involvement of stakeholders, especially those with lived experience in mental health and suicide prevention, has become important to government policy and practice at Federal and State levels. However, little is known about how governments translate this intention into frameworks of co-creation for policy, funding programs, service improvement, and research and evaluation. We investigated the extent to which publicly available government policies refer to collaborative practice using an established translation model., Methods: An exploratory directed and summative content analysis approach was used to analyse the contents of Federal (also known as Commonwealth), State and Territories policy documents on mental health and suicide prevention published in Australia between 2010 and 2021. The data was extracted, compared to an existing translation model, and summated to demonstrate the evidence of co-creation-related concepts between government and stakeholders., Results: 40 policy documents (nine at the Federal and 31 at the State and Territory level) were identified and included in the analysis. Only 63% of policy documents contained references to the concept of co-design. Six of the State policies contained references to the concept of co-production. Across all policy documents, there were no references to other concepts in the model adopted for this study, such as co-creation, co-ideation, co-implementation, and co-evaluation., Conclusion: Although the government at Federal, State and Territory levels appear to support collaborative practice through partnership and co-design, this study suggests a narrow approach to the theoretical model for co-creation at a policy level. Implications for both research and practice are discussed., (© 2022. The Author(s).)

Help seekers regularly present to Emergency Departments (EDs) when in suicidal crisis for intervention to ensure their immediate safety, which may assist in reducing future attempts. The emergency health workforce have unique insights that can inform suicide prevention efforts during this critical junction in an individual's experience with suicide. This paper explores the treatment and care delivery experiences of 54 health professionals working in EDs within one of the LifeSpan suicide prevention trial sites in Australia. Data was collected via six focus groups and six interviews. Thematic analysis resulted in three themes: (1) physicality of the emergency department, (2) juggling it all-the bureaucracy, practicalities, and human approach to care, and (3) impact of care delivery on ED staff. Findings highlight the need for workplace training that incorporates responding to the uncertainty of suicidal crisis, to compliment the solution-focused medical model of care. Broader policy changes to the ED system are also considered to ensure better outcomes for health professionals and help-seekers alike., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Rheinberger, Wang, McGillivray, Shand, Torok, Maple and Wayland.)

Background: Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement., Methods: The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed., Results: Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co-design or co-evaluation stage., Conclusion: This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the field of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed that the inclusion of co-researchers from communities or organizations is defined as co-creation, but further analysis revealed that collaboration was not consistent across the duration of projects. Researchers and practitioners should consider issues of power and equity in multisectoral collaborations and encourage increased engagement with TSOs, to rigorously research and evaluate suicide prevention services., (© 2022. The Author(s).)

For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for intervention and to ensure personal safety. However, negative ED experiences can deter individuals from returning, thus impacting future suicide risk. In order to improve the ED environment for individuals in suicidal crisis, an in-depth understanding of this experience is needed. In-depth semi-structured interviews with 17 help seekers and 16 support persons were conducted. A grounded theory approach uncovered a core organising concept-all participants wanted a "a sustained, productive, constructive relationship with someone who can help" during the ED visit-which guided analysis. Thematic analysis resulted in two themes and four subthemes exploring the systemic and interpersonal aspects of the ED visit and the roadblocks and pathways to development of the relationship. Interpersonal factors included aspects of staff interaction and presence of a support person. Systemic factors related to aspects controlled by the physical space and internal policies and procedures and included aspects such as the chaotic environment, long waiting times, and access to staff. Overwhelmingly, there were more roadblocks than pathways reported by participants. Improving the ED environment, increasing staff training and encouraging the presence of support persons may help mitigate some of these roadblocks.

The Continuum of Survivorship proposes a way in which individuals may experience the suicide death of someone known to them along a continuum from being exposed to the death through to long-term bereavement. The present study provides a first empirical testing of the proposed model in an Australian community sample exposed to suicide. Using a Latent Profile Analysis, we tested the suicide exposure risk factors (time since death, frequency of pre-death contact, reported closeness, and perceived impact) to map to the Continuum of Survivorship model. Results revealed identification of five profiles, with four ranging from suicide exposed to suicide bereaved long-term broadly aligning with the proposed model, with one further profile being identified that represented a discordant profile of low closeness and high impact of suicide exposure. Our findings demonstrate that while the proposed model is useful to better understand the psychological distress related to exposure to suicide, it cannot be used as "shorthand" for identifying those who will be most distressed, nor those who may most likely need additional support following a suicide death. Implications and future research directions are discussed., Competing Interests: MM was a member elected Director on the Board of Suicide Prevention Australia at the time this study survey was disseminated. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bhullar, Sanford and Maple.)

The Rana Plaza building collapse occurred on 24 April 2013 in Savar, near the capital city of Bangladesh, killing more than 1130 garment workers and injured about 2500, mostly females. Those who survived face ongoing challenges, including socio-cultural constraints, economic hardship, post-traumatic stress disorders (PTSD), depression, and critical health issues, which may lead to suicidal ideation and death. The aim of this article is to explore why and how female garment workers who survived the Rana Plaza collapse are now at risk of suicide thoughts and behaviours, and suicide death. Unstructured face-to-face interviews were held from April to July 2018 with 11 female garment workers who survived the Rana Plaza building collapse. Interviews continued until data saturation was reached. The interviews were tape-recorded and transcribed verbatim while simultaneously being translated into English from Bengali/Bangla. Transcripts were coded and thematically analysed. The study found that all participants were living with multiple risk factors of suicidal ideation (including low socio-economic status, poverty, social stigma, psychological distress, and trauma) which the participants directly linked to the collapse of the Rana Plaza building. Our analysis uses the three-step theory of suicide (3ST, Klonsky & May, 2015) to understand female Rana Plaza survivors' suicide risk. Female survivors' overall vulnerability requires urgent attention while taking the socio-cultural setting of Bangladesh into account. In addition, a lifelong caring system (combining financial security and free healthcare) needs to be initiated to accommodate the female survivors with mainstream society to avoid possible future suicides. They require long-term social and economic security and psychological support.

Despite high rates of critical incidents (CIs) in working class occupations, there is a significant gap in our understanding of responses to these events. In this study, we aimed to inform a response training module by synthesising the key elements of pre-, during- and post-incident responses to CIs and suicide in the workplace. A rapid review identified studies on responses to CIs or suicide deaths in the workplace published between January 2015 and June 2020. A systematic search of six databases (Medline, CINAHL, PsycINFO, Sociology Collection, Academic Search and Business Search Complete) and grey literature was performed. Studies were excluded if the focus was on non-colleagues. Two reviewers independently conducted record screening, a review of the full text and assessed study quality. The existing evidence was synthesised and interventions were categorised using Haddon's Matrix. Five studies were included, reporting on CIs across a range of workplace settings, including railways, factories, police and military, along with external critical response units. Overall, study quality was assessed as being poor. Most of the evidence focused on the pre-incident and post-incident stage. There is little evidence on responses to CIs in the workplace. Evidence-based education and training is necessary to establish organisational responses to assist with supporting workers exposed to workplace CIs.

Suicide prevention strategies internationally appear to be falling short of making a meaningful impact on global suicide deaths. Increasing the rates of general community participation in suicide research may improve knowledge generalisability as it relates to suicidal behaviour and leads to new suicide prevention approaches. This study aims to explore the motivations of a community-based sample to participate in suicide research. A subsample of the Australian general population took part in an online survey which is part of a multilevel suicide prevention trial. The survey concluded with an optional open-text question asking about peoples' motivations for participating in the study; 532 participants left a response to this question. These responses were qualitatively analysed using Thematic Network Analysis. Motivations to participate in suicide research were represented by four global themes: altruism, solve systemic problems, lived experience, and personal benefit. Of these themes, three were focused on the benefit of others, while only the final theme articulated motivation to participate that was self-focused. The impact of suicide is felt throughout the wider community. This new understanding of the motivations of community-based samples to participate in suicide research should be used to increase participation rates and reach people who would not normally contribute their voice to suicide research.

This paper describes the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on the readymade garment (RMG) workers of Bangladesh. It articulates the RMG workers' existing vulnerability during the COVID-19 pandemic based on currently available evidence and personal conversations/communications with RMG workers. COVID-19 has already impacted RMG workers' health (both physical and mental health status) and wellbeing, and resulted in loss of employment. We argue that the COVID-19 pandemic will have long-lasting effects on the garment workers, especially related to their health issues, financial hardship and inability to pay for essentials such as food, and future employment opportunities. The stakeholders (such as the international retailers/brands, Bangladesh Garment Manufacturers and Exporters Association, Government of Bangladesh) responsible for the global supply chain RMG factories should reconsider the health and overall wellbeing needs of the RMG workers during the ongoing COVID-19 pandemic., (© The Author(s) 2020. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: For individuals presenting to the emergency department (ED) for a suicide attempt, the period after discharge from hospital is marked by heightened vulnerability for further suicide attempts. Effective care following a suicidal crisis has the potential to significantly decrease this risk. The current study aims to examine the impact of the LifeSpan multilevel suicide prevention model on experiences of care following a suicidal crisis. Perspectives from healthcare consumers (individuals who have presented to the ED following a suicidal crisis), carers, and health professionals will be explored. The LifeSpan model is currently being evaluated as a high-fidelity trial in four geographically defined regions in New South Wales, Australia., Methods and Analysis: This study will use a mixed methods prospective cohort design. Quantitative data collection includes a structured survey, administered to healthcare consumers from LifeSpan sites and control sites. Two cohorts of healthcare consumers will be recruited 12 months apart with baseline assessment occurring within 18 months of the ED presentation, and follow-up 12 months after the initial assessment. Survey participants will be recruited online and through participating EDs, mental health organisations and aftercare services. Qualitative interview data from healthcare consumers, carers who have accompanied a loved one to the ED following a suicidal crisis and health professionals who provide care to people at risk of suicide will be collected concurrently with the recruitment of the first cohort of survey participants. Purposive and convenience sampling techniques will be used for recruitment of interview participants. The primary outcome for this study will be healthcare consumers' experiences of service provided at the ED. Analysis will be undertaken of the change over time within LifeSpan sites, as well as between LifeSpan sites and control sites, using mixed effects repeated measures models as principal means of data analysis., Ethics and Dissemination: This research has been approved by the Hunter New England Human Research Ethics Committee (HREC/17/HNE/144). Results will be disseminated via conferences and peer-reviewed journals., Trial Registration Number: ACTRN12617000457347., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

: People with a lived experience of suicide are commonly included within suicide prevention research. This includes participation in conferences, policy development, research and other activities. Yet little is known about the impact on the person in the long term of regularly sharing one's experience to different audiences and, in some cases, to a schedule not of your choosing. This qualitative study asked twenty people to share their reflections of being lived experience representatives within suicide prevention. Participants varied in the length of time they had been sharing their stories, and how they shared with different audiences. These narratives were thematically analysed within a reflective framework, including field notes. Four broad themes were noted that highlighted participants' recommendations as to how the lived experience speaker training could grow alongside suicide prevention activities to facilitate safe activities that include a shared understanding of the expected outcome from participation. The environment for people with lived experience of suicide to tell their stories already exists, meaning that the suicide prevention sector needs to move quickly to ensure people understand the variety of spaces where lived experience needs to be incorporated, evaluated and better supported. When lived experience is a valued inclusion in the creation of effective and appropriate suicide prevention research and interventions, those who share their experience must be valued and supported in a way that reflects this. This study recommends strategies to practically and emotionally support speakers, including ways to ensure debriefing and support, which can enhance the longevity of the speakers in the suicide prevention space by valuing the practical and emotional labour required to be suicide prevention representatives, with an outcome recommendation for best practice guidelines for those who engage people with lived experience in suicide prevention activities., Competing Interests: The authors declare no conflict of interest.

Background: Exposure to parental death in childhood has been strongly associated with offspring suicide although few studies have applied theoretical models to conceptualise this relationship., Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Reviews guidelines, we conducted a scoping review of primary studies that identified a theory/framework explaining the aetiology of suicidal behaviour in adulthood, following childhood exposure to external-cause parental death, including suicide., Results: The search yielded 1598 articles. Following full-text screening, 23 studies were identified as meeting inclusion criteria. Data extraction was then completed and found that the studies collectively referenced nine theories. The specific theories identified covered a range of biopsychosocial frameworks and included attachment theory, familial transmission of suicide, conservation of resources framework, diathesis-stress model, social integration theory, socio-ecological model, social learning theory, critical period hypothesis or life course approach and the developmental model of antisocial behaviour., Limitations: It was beyond the scope of this review to conduct rigorous testing and evaluation of the theories identified. Future research could extend on this study by developing criteria to assess the range of theories and frameworks on suicide exposure, as well as the studies providing evidence for these theories, in order to guide more advanced theory development as well as policies, programs and interventions., Conclusions: Based on these theories, the authors proposed that using an integrated biopsychosocial model will provide a more comprehensive understanding of the diverse risk and protective factors for suicidal behaviour following parental death., (© 2020 Published by Elsevier Ltd.)

Co-creation of new knowledge has the potential to speed up the discovery and application of new knowledge into practice. However, the progress of co-creation is hindered by a lack of definitional clarity and inconsistent use of terminology. The aim of this paper is to propose a new standardised definition of co-creation of new knowledge for health interventions based on the existing co-creation literature. The authors completed a systematic search of electronic databases and Google Scholar using 10 of the most frequently used co-creation-related keywords to identify relevant studies. Qualitative content analysis was performed, and two reviewers independently tested the categorisation of papers. Of the 6571 papers retrieved, 42 papers met the inclusion criteria. Examination of the current literature on co-creation demonstrated how the variability of co-creation-related terms can be reduced to four collaborative processes: co-ideation, co-design, co-implementation and co-evaluation. Based on these four processes, a new definition of co-creation of new knowledge for health interventions is proposed . The analysis revealed the need to address the conceptual ambiguity of the definition of "co-creation of new knowledge". The proposed new definition may help to resolve the current definitional issues relating to co-creation, allowing researchers and policymakers to progress the development of co-creation of new knowledge in research and practice., Competing Interests: The authors declare no conflict of interest.

(1) Background: First-hand accounts of lived experience of suicide remain rare in the research literature. Increasing interest in the lived experience of suicide is resulting in more opportunities for people to participate in research based on their personal experience. How individuals choose to participate in research, and their experience of doing so, are important considerations in the ethical conduct of research. (2) Methods: To understand the experience of providing care for someone who has previously attempted suicide, a cross-sectional online community survey was conducted. This survey concluded with questions regarding motivation to participate and the experience of doing so. Of the 758 individuals who participated in the survey, 545 provided open-ended text responses to questions regarding motivation and 523 did so for questions regarding the experience of participating. It is these responses that are the focus of this paper. Data were analysed thematically. (3) Results: Motivations to participate were expressed as primarily altruistic in nature, with a future focus on improving the experience of the person who had attempted suicide alongside carers to ease distress. The experience of participating was difficult yet manageable, for all but a few participants. (4) Conclusions: With the increasing interest in first-hand accounts of suicide, how individuals experience participation in research is an important focus that requires further attention.

Those who attempt suicide have often been overlooked in the suicide prevention literature. Where stories of lived experience have been included, it is often from the perspectives of healthcare professionals who treat the physical and/or psychological impacts following an attempt, rather than firsthand accounts. Yet, the most intimate insights of suicide are lost by not including the voices of those with lived experience of suicide attempt. Through an online, community-based, non-representative survey exploring the impact of exposure to suicide, a sub-sample of 88 participants responded who reported their exposure to suicide as being their own attempt. The survey covered demographic information, questions assessing exposure to suicide attempts and death, current global psychological distress via the Kessler Psychological Distress (K10) Scale, and short qualitative responses provided by 46 participants. The qualitative data was thematically analysed resulting in three themes; the way in which individuals experienced being suicidal; who they were able, or not, to disclose these intentions to-before and after their suicide attempt; and, how these people experienced the formal and informal health care supports available to them to assist with their suicidal crisis. This paper presents important findings from a sample of participants who are highly distressed, and have previously attempted to take their own lives. This adds depth to our understanding of lived experience of suicide attempt, issues associated with seeking appropriate support after suicide attempt, and also demonstrates a willingness of participants to share their stories, even in a study that did not explicitly target those with lived experience of suicide attempt. The need for consistent and compassionate mental health care after a suicide attempt is identified as a vital component of living well after a suicide attempt.

This study aims to identify the ongoing physical and psychological health vulnerabilities of the readymade garment (RMG) factory workers involved in the Rana Plaza building collapse in 2013, along with their experiences within the current socioeconomic and political contexts of Bangladesh. Seventeen Rana Plaza survivors participated in unstructured, face-to-face, in-depth interviews. Interviews were thematically analyzed using Haddon's matrix to examine pre-event, event, and post-event injury experiences. The collapse of the Rana Plaza building resulted in significant physical and emotional trauma for those who survived the event. The majority of the participants were forced to attend work on the day of the collapse. Participants reported physical health complaints related to bone injuries/fractures and amputation, severe headache, kidney problems, and functional difficulties. In addition to the reported physical health issues, the participants revealed psychological health issues including trauma, depression and suicidal ideation, sleep disorders, anxiety, and sudden anger. Participants described barriers to their potential for re-employment in the RMG sector and outlined their limited access to free healthcare for follow-up treatment. Those who survived the collapse of the Rana Plaza building continue to experience significant adverse physical and emotional outcomes related to the disaster. Yet, they have little recourse to ensure the availability of adequate health care and rehabilitation. Given the international reliance on the Bangladeshi RMG industry, continued pressure to ensure care is provided for these survivors, and to reduce the risk of future disasters, is necessary.

Background: There is a paucity of literature that addresses the health vulnerabilities of readymade garment (RMG) workers in South and Southeast Asian regions. Therefore, the aim of this systematic review is to identify the distinctive types of health vulnerabilities along with the causes and consequences of these vulnerabilities of the RMG workers in South and Southeast Asian regions., Methods: Systematic review search methods were applied utilising the PRISMA protocol. Literature published between July 2007 to June 2017 on health vulnerabilities of the RMG workers of South and Southeast Asian countries were identified through electronic databases and manual searches., Results: A total number of 19 studies (16 quantitative studies, 3 mixed-method studies) were included from the primary 17,001 papers identified. The quality of these studies was assessed by using the EPHPP (effective public health practice project) and the CASP (critical appraisal skills programme) tools. From the identified studies, 14 were considered 'strong,' with the remainder assessed as 'moderate' quality. The findings reported in these studies suggest that RMG workers of South and Southeast Asian countries are prone to several health vulnerabilities which include physical and psychological issues. Further, many of these health vulnerabilities arise from the nature of the RMG workplace, and include unhygienic and unsafe working environments, hazardous conditions of the factories, and lack of safety equipment., Conclusions: This systematic review suggests that RMG workers' health vulnerabilities are an emerging area of inquiry that needs to be better understood and solutions identified. Little is currently known about the distinctive types of health vulnerabilities of the RMG workers of these countries, other than Bangladesh and India, due to the lack of robust studies in other South and Southeast Asian countries. Although the health vulnerabilities of the Bangladeshi and Indian RMG workers have been previously highlighted, the health vulnerabilities arising from sudden disasters in the sector remain a neglected issue.

Introduction: Rural health workforce shortages are a global phenomenon. Countries like Australia, with industrialised economies, large land masses and broadly dispersed populations, face unique rural health challenges in providing adequate services and addressing workforce shortages. This article focuses on retention of early-career nursing and allied health professionals working in rural and remote Australia. Some of Australia's most severe and protracted rural workforce shortages, particularly among early-career health professionals, are in public sector community mental health (CMH), a multidisciplinary workforce staffed primarily by nurses and allied health professionals. This study investigated how employment and rural-living factors impacted the turnover intention of early-career, rural-based CMH professionals in their first few years of working., Methods: A constructivist grounded theory methodological approach, primarily guided by the work of Charmaz, was selected for the study. By implication, the choice of a grounded theory approach meant that the research question would be answered through the development of a substantive theory. Twenty-six nursing and allied health professionals working in CMH in rural New South Wales (NSW) for the state health department services participated in in-depth, semi-structured interviews. The study sought to identify the particular life factors - workplace conditions, career-advancement opportunities and social and personal determinants - affecting workers' turnover intention. The substantive grounded theory was developed from an identified core category and basic social process., Results: The turnover intention theory provides a whole-of-person explanation of turnover intention. It was developed based on an identified core category of professional and personal expectations being met and an identified basic social process of adjusting to change. The theory posits that an individual's decision to stay or leave their job is determined by the meeting of life aspirations, and this relates to the extent of the gap between individuals' professional and personal expectations and the reality of their current employment and rural-living experience. The extent of individuals' professional and personal expectations can be measured by their satisfaction levels. A major finding from the identification of the basic social process was that, in the adjustment stages (initial and continuing), turnover intention was most strongly affected by professional experiences, in particular those relating to the job role, workplace relationships and level of access to continuing professional development. In this stage, personal satisfaction mostly concerned those with limited social connections in the town (ie non-local - newcomers). Having reached the 'having adapted' stage, the major influence on turnover intention shifted to personal satisfaction, and this was strongly impacted by individuals' life stage. By drawing on the turnover intention theory and the basic social process, it is possible to make a risk assessment of individuals' turnover intention. Three levels of risk were identified: highly vulnerable, moderately vulnerable and not very vulnerable., Conclusions: The study offers a holistic explanation of life factors influencing the turnover intention of early-career health professionals working in public health services in rural NSW. These findings and the turnover intention risk matrix are thought to be suitable for use by Australian public health services and governments, as well as in other highly industrialised countries, to assist in the development of policies and strategies tailored for individual health professionals' work-experience level and life stage. By adopting such a whole-of-person approach, health services and governments will be better positioned to address the life aspirations of rural-based, early-career health professionals and this is likely to assist in the reduction of avoidable turnover.

Background: Young people who engage in multiple risk behaviour (high-risk young people) such as substance abuse, antisocial behaviour, low engagement in education and employment, self-harm or suicide ideation are more likely to experience serious harms later in life including homelessness, incarceration, violence and premature death. In addition to personal disadvantage, these harms represent an avoidable social and economic cost to society. Despite these harms, there is insufficient evidence about how to improve outcomes for high-risk young people. A key reason for this is a lack of standardisation in the way in which programs provided by services are defined and evaluated., Methods: This paper describes the development of a standardised intervention model for high-risk young people. The model can be used by service providers to achieve greater standardisation across their programs, outcomes and outcome measures. To demonstrate its feasibility, the model is applied to an existing program for high-risk young people., Conclusions: The development and uptake of a standardised intervention model for these programs will help to more rapidly develop a larger and more rigorous evidence-base to improve outcomes for high-risk young people.

Background: There is little evidence about how to improve outcomes for high-risk young people, of whom Indigenous young people are disproportionately represented, due to few evaluation studies of interventions. One way to increase the evidence is to have researchers and service providers collaborate to embed evaluation into the routine delivery of services, so program delivery and evaluation occur simultaneously. This study aims to demonstrate the feasibility of integrating best-evidence measures into the routine data collection processes of a service for high-risk young people, and identify the number and nature of risk factors experienced by participants., Methods: The youth service is a rural based NGO comprised of multiple program components: (i) engagement activities; (ii) case management; (iii) diversionary activities; (iv) personal development; and (v) learning and skills. A best-evidence assessment tool was developed by staff and researchers and embedded into the service's existing intake procedure. Assessment items were organised into demographic characteristics and four domains of risk: education and employment; health and wellbeing; substance use; and crime. Descriptive data are presented and summary risk variables were created for each domain of risk. A count of these summary variables represented the number of co-occurring risks experienced by each participant. The feasibility of this process was determined by the proportion of participants who completed the intake assessment and provided research consent., Results: This study shows 85% of participants completed the assessment tool demonstrating that data on participant risk factors can feasibly be collected by embedding a best-evidence assessment tool into the routine data collection processes of a service. The most prevalent risk factors were school absence, unemployment, suicide ideation, mental distress, substance use, low levels of physical activity, low health service utilisation, and involvement in crime or with the juvenile justice system. All but one participant experienced at least two co-occurring domains of risk, and the majority of participants (58%) experienced co-occurring risk across four domains., Conclusions: This is the first study to demonstrate that best-evidence measures can feasibly be embedded into the routine data collection processes of a service for high-risk young people. This process allows services to tailor their activities to the most prevalent risks experienced by participants, and monitor these risks over time. Replication of this process in other services would improve the quality of services, facilitate more high quality evaluations of services, and contribute evidence on how to improve outcomes for high-risk young people.

Objective: To identify evaluations of interventions that target multiple risk factors in high-risk young people, describe their characteristics, critique their methodological quality and summarise their effectiveness., Methods: A search of the literature published between 2009 and 2014 identified 13 evaluations of interventions that targeted multiple risk factors, compared to 95 evaluations that targeted single risk factors. The methodological adequacy of the 13 evaluation studies was analysed using the Quality Assessment Tool for Quantitative Studies and information regarding characteristics and intervention effectiveness was extracted and summarised., Results: There were very few outcome evaluation studies of interventions that targeted multiple risk factors, relative to single risk factors, among high-risk young people. Of the identified studies, half were methodologically weak. Interventions delivered in community settings targeted a greater number of risk factors, while those delivered in a school or health setting reported a higher proportion of statistically significant outcomes. No economic analyses were conducted. Conclusions and Implications for Public Health: More methodologically rigorous evaluations of interventions targeting multiple risk factors among high-risk young people are required, especially for those delivered in community settings. Four key areas for improvement are: i) more precisely defining the risk factors experienced by high-risk young people; ii) achieving greater consistency across interventions; iii) standardising outcome measures; and iv) conducting economic analyses., (© 2016 The Authors.)

Objectives: To explore understanding, perceptions and feelings about meningococcal disease in members of higher risk groups. To explore what people say are the most important health messages and communication preferences about invasive meningococcal disease (IMD)., Methods: Three focus groups and two semistructured interviews were conducted with people at higher risk of IMD in Hunter New England Local Health District in New South Wales., Results: Participants generally had a low understanding of IMD, but described intense feelings about the disease and empathy for those who had experienced the disease. Fear of stigma and the impact of stigma were identified. Participants identified reasons for delaying presentation for care as perceptions of invincibility (particularly among young people), the cost of care (for all groups), and racism (particularly for Aboriginal people). These issues were both potential and experienced barriers for participants accessing help when acutely unwell. Factors for effective communication to improve understanding of IMD included the communication being acceptable, accessible and appropriate., Conclusions: IMD is a serious but uncommon disease that has a range of impacts on people, families and communities. Higher risk groups may benefit from receiving more appropriate and accessible information about early signs and symptoms of IMD. Communication and understanding about the disease could be improved by working with new technologies and partnering with key people in high-risk groups. Use of text messages and social networking for urgent communication could be considered and trialled in public health practice. It is also important to recognise the potential direct or indirect experience of racism and stigma for patients with IMD and their families. Management of IMD could be strengthened by connecting people and families with support groups or services to reduce the impact of the disease.

Objective: Suicide has been identified as a major public health issue. Exposure to suicide (i.e., knowing someone who died by suicide) is far more pervasive than previously considered and might be associated with significant adverse outcomes. As suicide becomes more commonly discussed in the public arena, a compelling need exists to determine who is exposed to suicide and how this exposure affects those left behind. This study estimated the proportion of the population exposed to suicide and delineated factors that predict significant psychiatric and psychosocial morbidity following that exposure., Methods: A dual-frame random-digit-dial survey was conducted on a sample of 1,736 U.S. adults in the Commonwealth of Kentucky. Depression and anxiety were compared in suicide-exposed and suicide-unexposed individuals. Relationships were examined between psychiatric outcomes and perceptions of closeness to the decedent., Results: Forty-eight percent of weighted participants (n=816/1,687) reported lifetime exposure to suicide. Current depression and anxiety symptoms were higher in suicide-exposed than in suicide-unexposed individuals. Suicide-exposed individuals were twice as likely as suicide-unexposed individuals to have diagnosable depression and almost twice as likely to have diagnosable anxiety. Suicide-exposed individuals were more likely than suicide-unexposed individuals to report suicide ideation (9% vs. 5%). Closeness to the decedent increased the odds of depression and anxiety and almost quadrupled the odds of posttraumatic stress disorder., Conclusion: Exposure to suicide is pervasive and occurs beyond family; as such, it is imperative to identify those with perceived closeness to the decedent. This hidden cohort of suicide-exposed people is at elevated risk for psychopathology and suicidal ideation.

Context: Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners., Issues: FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities., Lessons Learned: Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.