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Objective: This rapid review aimed to understand the rates of suicidal ideation and behaviours in men who are separated from intimate relationships, the co-occurrence of risk factors, and the effectiveness of suicide prevention interventions for them in order to inform future suicide prevention efforts. Method: The review method followed a streamlined systematic review process which facilitates an expedited review of the evidence related to the review questions. We searched three academic databases (Cochrane, Medline and PsycINFO) for peer-reviewed articles published between 2010 and 2019 in English using keywords related to men who are separated from an intimate relationship; suicidal thoughts, attempts and deaths; suicide rates; and suicide prevention interventions. Results: Four systematic reviews and 22 papers featuring primary studies were included in the review relating to suicide rates and risk. No papers were identified relating to the effectiveness of suicide prevention interventions for this group. The evidence base was rated as good. The findings suggest that men who are separated from an intimate relationship are at higher risk of suicide. Discussion: The review identified an increased risk of suicide among men who are separated, but no evidence about the effectiveness of suicide prevention interventions for them. More work is needed to unpack the interplay between personal and sociodemographic factors and the risk of suicide for separated men in order to inform suicide prevention efforts with these men.

People at risk of suicide frequently communicate suicidal thoughts to professionals and non-professionals. These groups, therefore, need to be aware of how best to respond.We aimed to identify helpful and unhelpful responses to communications of suicide risk from the perspective of those at risk to inform suicide prevention messaging and education.We conducted an online survey (Most respondents had repeatedly considered and attempted suicide. Indirect suicide communications were more common than direct communications. Listening without judgement was the most common helpful response and "minimizing" responses to suicidal thoughts and feelings, the most common unhelpful responses.We make recommendations for suicide prevention messages and professional education content based on these findings.

Youth suicide is a major public health concern worldwide. Public service announcements (PSAs) may have a role in suicide prevention, as part of broader suicide prevention campaigns.We conducted a double-blind four arm randomized controlled trial in which 18 to 24 year olds were allocated to watch one of three suicide prevention PSAs intervention PSAs or a control PSA. Participants provided data prior to viewing their allocated PSA and again four weeks after viewing it. Our primary outcome was a change in participants' attitudes toward the preventability of suicide, and analysis was conducted on an intention-to-treat basis.A total of 349 participants were randomized to one of four groups and 266 participants provided pre and post viewing data. Across the four groups, no significant change was observed in our primary outcome: attitudes toward the preventability of suicide (Our study has highlighted that attitudes and help-seeking intentions in young adults are difficult to change with low intensity one-off exposure to PSA messages. Further research is required to understand the factors that contribute to safe and effective messaging about suicide prevention.

OBJECTIVE: We aimed to identify Australian adults' current level of confidence and intentions to help a person close to them in distress or at risk of suicide to inform the content and targeting of suicide prevention messages aimed at family and friends of those at risk. METHODS: We conducted a nationally representative computer-assisted telephone survey of confidence and intentions to help someone in distress or at risk of suicide (n = 3,002). We used logistic regression to determine whether sociodemographic and exposure variables predicted confidence and intentions to help. RESULTS: Confidence to help was high. About half of the respondents had intentions inconsistent with best practice. Listening and talking, and encouraging the person to seek professional help were the most common types of intended helping actions. Intentions to ask suicide risk assessment questions were least common. Men were more likely than women to have intentions to carry out nonrecommended actions, and less likely to have intentions to carry out recommended actions. CONCLUSIONS: Suicide prevention messaging aimed at family and friends could encourage them to ask direct questions about suicide risk and could include messages about "what not to do." Suicide prevention messages aimed specifically at men are indicated.

Abstract. Background: A suicide prevention media campaign aimed at family members and friends may be one useful population-level suicide prevention strategy for Australia. However, currently there is limited evidence of what messages would be acceptable and appropriate for inclusion. Aims: This expert consensus study aimed to identify messages that experts with lived experience of suicide risk and suicide prevention professionals believed were most important to include in such a suicide prevention campaign. Method: Using an online survey method, 127 participants with lived experience (lived experience group) and 33 suicide prevention professionals (suicide prevention professionals group) rated 55 statements, drawn from an earlier Delphi study, from very low priority to very high priority for inclusion in a suicide prevention campaign. Results: There was significant agreement within and between the two participant groups on the most highly rated messages for inclusion. The mostly highly rated messages were that family members or friends should ask directly about suicidal thoughts and intentions, listen to responses without judgment, and tell the person at risk that they care and want to help. Limitations: We restricted ratings to just one round and may therefore have limited the level of consensus achieved. Use of a predefined set of suicide prevention messages might also have prevented us from identifying other important messages. Lived experience participants were drawn from one source and this might bias their responses through exposure to common suicide prevention messages that influence their points of view. Conclusion: There is substantial agreement between professionals and people with lived experience on the most important messages to include in a suicide prevention campaign. These most highly rated messages could be adopted in a suicide prevention media campaign.

The Access to Allied Psychological Services (ATAPS) Suicide Prevention Services initiative is an Australian Government-funded primary mental healthcare initiative providing free intensive psychological intervention for consumers at moderate risk of self-harm or suicide. Findings from a multi-method evaluation aimed at identifying whether the initiative is being implemented as stipulated within the operational guidelines, barriers and facilitators to implementation, and preliminary outcomes suggest that the Suicide Prevention Services are largely being implemented as stipulated in the Guidelines, but with some exceptions. In particular, service delivery barriers unique to rural and remote areas place limitations on implementation. Uptake of the ATAPS Suicide Prevention Services is high (10,428 consumers were referred to the Suicide Prevention Services between October 2008 and April 2013, and 86% of those attended at least one session), as is acceptance from organizations involved in its implementation.

Suicide prevention media campaigns are gaining traction as a means of combatting suicide. The current review set out to synthesize information about the effectiveness of these campaigns. We searched four electronic databases for studies that provided evidence on the effectiveness of media campaigns. We focused on studies that described an evaluation of the effectiveness of an entire campaign or a public service announcement explicitly aimed at suicide prevention. We identified 20 studies of varying quality. Studies that looked at whether campaign exposure leads to improved knowledge and awareness of suicide found support for this. Most studies that considered whether campaign materials can achieve improvements in attitudes toward suicide also found this to be the case, although there were some exceptions. Some studies found that media campaigns could boost help-seeking, whereas others suggested that they made no difference or only had an impact when particular sources of help or particular types of help-seeking were considered. Relatively few studies had sufficient statistical power to examine whether media campaigns had an impact on the ultimate behavioral outcome of suicides, but those that did demonstrated significant reductions. Our review indicates that media campaigns should be considered in the suite of interventions that might be used to prevent suicide. Evidence for their effectiveness is still amassing, but there are strong suggestions that they can achieve positive results in terms of certain suicide-related outcomes. Care should be taken to ensure that campaign developers get the messaging of campaigns right, and further work is needed to determine which messages work and which ones do not, and how effective messages should be disseminated. There is an onus on those developing and delivering campaigns to evaluate them carefully and to share the findings with others. There is a need for evaluations that employ rigorous designs assessing the most pertinent outcomes. These evaluations should explore the nature of given campaigns in detail - in particular the messaging contained within them - in order to tease out which messages work well and which do not. They should also take into account the reach of the campaign, in order to determine whether it would be reasonable to expect that they might have their desired effect.

We conducted a nationally representative telephone survey of 3000 Australian adults. We assessed helping responses toward people in severe distress and experiencing suicidal thoughts by asking whether respondents had undertaken 15 specified helping actions (10 recommended and 5 non-recommended actions) to support such a person. We also asked respondents who had experienced suicidal ideation in the last 12 months whether the most helpful person at that time had undertaken the 15 specified helping actions. We weighted the data to represent the Australian adult population, calculated percentage frequencies for the helping actions and used logistic regression to analyse whether sociodemographic and exposure variables related to helping actions taken. Recommended supportive actions consistent with best practice were most commonly undertaken (e.g., listened to their problems without judgement: 96.5%, 95% CI 94.6–97.7); however, some non-recommended actions (e.g., reminded the person what they have they going for them: 91.6%, 95% CI 89.1–93.5) were also very common. Suicide risk assessment actions such as asking if they had a plan for suicide (39.8%; 95% CI 35.0–44.9), and encouraging professional help (e.g., helped make an appointment with a health professional: 61.3%, 95% CI 57.4–65.2) were relatively uncommon. Age, gender, level of education, language spoken at home, own suicidal ideation and suicide prevention training were shown to affect the odds of carrying out various helping actions. Australian adults need to be educated to ask direct questions about suicide risk and to encourage others in distress to seek professional help. There may also be a place for discouraging certain behaviours that oppose best practice in suicide prevention. While most previous studies have assessed intentions to help a person at risk of suicide, this study makes a unique contribution to the literature by assessing ‘real-world’ helping behaviour, including the occurrence of helping actions undertaken that oppose best practice in suicide prevention., Highlights • Surveys a nationally representative sample of Australian adults (n = 3000). • Identifies helping actions from non-professionals toward people at risk of suicide. • Finds that actions opposing suicide prevention best practice are common. • Finds that asking questions to assess suicide risk is uncommon. • Actions taken predicted by sociodemographics, suicidal ideation and training.

Background Debunking suicide myths, such as ‘asking someone about suicide could make them start thinking about it’ is a common strategy in suicide prevention education. However, there has been little research investigating the relationship between suicide myths and helping behavior toward people at risk of suicide. We aimed to identify sociodemographic characteristics associated with belief in eight common suicide myths and the associations between beliefs in these myths and helping intentions and behaviors toward a family member or friend in severe distress or at risk of suicide. Methods We conducted a random digit dial (mobile and landline) survey of 3002 Australian adults. We asked respondents about their beliefs in suicide myths, intentions to help a person in severe distress or at risk of suicide presented in a vignette, and helping actions taken toward such a person in the last 12 months. We weighted this data to be representative of the Australian population. Regression analyses were undertaken to determine associations between sociodemographic and exposure characteristics and beliefs in suicide myths, and between beliefs in myths and helping intentions and behaviors. Results Being male, speaking a language other than English at home and being over 60 years were associated with the strongest beliefs in suicide myths. The strongest and most consistent associations were found between belief in the myth ‘asking someone about suicide could make them start thinking about it’, risk assessment intentions and behaviours and intentions to undertaken actions not recommended for suicide prevention. Conclusions Identifying those sociodemographic groups most likely to believe in suicide myths allows targeted intervention for suicide prevention education ‘debunking’ suicide myths. By isolating those myths that are most commonly believed, and their specific effects on helping intentions and behaviors, suicide prevention educators can target these specific myths to have the most effect on helping behavior. Our findings suggest that targeting the myth ‘asking someone about suicide could make them start thinking about it’ may have the greatest effects on helping behavior, and that men, those aged over 60 years and those speaking a language other than English at home could most benefit from myth ‘debunking’.

Much of our knowledge about the risk factors for suicide comes from case–control studies that either use a psychological autopsy approach or are nested within large register-based cohort studies. We would argue that case–control studies are appropriate in the context of a rare outcome like suicide, but there are issues with using this design. Some of these issues are common in psychological autopsy studies and relate to the selection of controls (e.g. selection bias caused by the use of controls who have died by other causes, rather than live controls) and the reliance on interviewing informants (e.g. recall bias caused by the loved ones of cases having thought about the events leading up to the suicide in considerable detail). Register-based studies can overcome some of these problems because they draw upon contain information that is routinely collected for administrative purposes and gathered in the same way for cases and controls. However, they face issues that mean that psychological autopsy studies will still sometimes be the study design of choice for investigating risk factors for suicide. Some countries, particularly low and middle income countries, don't have sophisticated population-based registers. Even where they do exist, there will be variable of interest that are not captured by them (e.g. acute stressful life events that may immediately precede a suicide death), or not captured in a comprehensive way (e.g. suicide attempts and mental illness that do not result in hospital admissions). Future studies of risk factors should be designed to progress knowledge in the field and overcome the problems with the existing studies, particularly those using a case–control design. The priority should be pinning down the risk factors that are amenable to modification or mitigation through interventions that can successfully be rolled out at scale.

Media campaigns have received increased attention as an intervention for combating suicide. Suicide prevention campaigns involving public service announcements (PSAs) have not been well described and have been subject to minimal evaluation. This study aimed to identify suicide prevention PSAs from around the world and analyze and describe their content. We searched the Internet for short, English-language PSAs that had been screened as part of suicide prevention campaigns and identified 35. Most commonly, these PSAs focused on the general population and/or people who might be at risk of suicide, and had a particular emphasis on young people. Almost 60% promoted open discussion about suicide, around 50% indicated that the life of a suicidal person was important, about 40% acknowledged the suffering associated with suicidal thoughts and feelings, about 25% stressed that suicide is preventable, and about 20% focused on the devastating impact of suicide for those left behind. Most PSAs promoted some sort of support for people at risk of suicide, usually a helpline or website. Although these messages appeared appropriate and practical there is a lack of research on the impact that they may have on people with varying degrees of suicide risk. Further work is needed to ensure that they are consistent with theories of behavior change, and that they are having their desired impacts.

Background Members of the public can potentially take action to assist someone in their social network who is distressed and at risk of suicide. The present study used data from a community survey to examine training experiences and sociodemographic factors associated with the quality of assistance provided in such situations. Methods A national telephone survey using random digit dialing was carried out with Australian adults on attitudes and intentions toward helping someone in severe distress or at risk of suicide, as well as actions taken. Participants were asked open-ended questions about their intentions to assist a hypothetical person in a vignette and about any actions they took to assist a family member or friend in distress over the previous 12 months. Each participant randomly received 1 of 6 vignettes which varied by gender and degree of suicidality portrayed. 3002 participants provided data on intentions and 932 on actions taken. Quality of Intentions and Quality of Actions were scored on 12-point scales. Results Quality of Intentions and Quality of Actions correlated 0.28. Quality of Intentions was associated with more overt suicidality in the vignette, age 31–59 years, female gender, university education, speaking English at home, being non-Indigenous and all forms of suicide training (professional, Mental Health First Aid and other). Quality of Actions was associated with female gender, university education and other suicide training. Conclusions Training on suicide prevention is associated with better quality of intentions and actions to help a person at risk of suicide. There are sub-groups in the population who are in greater need of such training because they have poorer quality of intentions to help and are less likely to have received training. These include males, less educated people and people from non-English speaking backgrounds. Electronic supplementary material The online version of this article (10.1186/s12888-019-2050-6) contains supplementary material, which is available to authorized users.

A suicide prevention media campaign aimed at family members and friends may be one useful population-level suicide prevention strategy for Australia. However, currently there is limited evidence of what messages would be acceptable and appropriate for inclusion.This expert consensus study aimed to identify messages that experts with lived experience of suicide risk and suicide prevention professionals believed were most important to include in such a suicide prevention campaign.Using an online survey method, 127 participants with lived experience (lived experience group) and 33 suicide prevention professionals (suicide prevention professionals group) rated 55 statements, drawn from an earlier Delphi study, from very low priority to very high priority for inclusion in a suicide prevention campaign.There was significant agreement within and between the two participant groups on the most highly rated messages for inclusion. The mostly highly rated messages were that family members or friends should ask directly about suicidal thoughts and intentions, listen to responses without judgment, and tell the person at risk that they care and want to help.We restricted ratings to just one round and may therefore have limited the level of consensus achieved. Use of a predefined set of suicide prevention messages might also have prevented us from identifying other important messages. Lived experience participants were drawn from one source and this might bias their responses through exposure to common suicide prevention messages that influence their points of view.There is substantial agreement between professionals and people with lived experience on the most important messages to include in a suicide prevention campaign. These most highly rated messages could be adopted in a suicide prevention media campaign.

Background: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. Methods. We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?'. Results: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. Conclusions: More well-designed intervention studies are needed to strengthen this evidence base. © 2013 Cox et al.; licensee BioMed Central Ltd., published_or_final_version