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Objectives: Little is known about how complex, multilevel, and multicomponent suicide prevention interventions work in real life settings. Understanding the methods used to systematically adopt, deliver, and sustain these interventions could ensure that they have the best chance of unfolding their full effect. This systematic review aimed to examine the application and extent of utilisation of implementation science in understanding and evaluating complex suicide prevention interventions., Methods: The review adhered to updated PRISMA guidelines and was prospectively registered with PROSPERO (CRD42021247950). PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL were searched. All English-language records (1990-2022) with suicide and/or self-harm as the primary aims or targets of intervention were eligible. A forward citation search and a reference search further bolstered the search strategy. Interventions were considered complex if they consisted of three or more components and were implemented across two or more levels of socio-ecology or levels of prevention., Results: One hundred thirty-nine records describing 19 complex interventions were identified. In 13 interventions, use of implementation science approaches, primarily process evaluations, was explicitly stated. However, extent of utilisation of implementation science approaches was found to be inconsistent and incomprehensive., Limitations: The inclusion criteria, along with a narrow definition of complex interventions may have limited our findings., Conclusion: Understanding the implementation of complex interventions is crucial for unlocking key questions about theory-practice knowledge translation. Inconsistent reporting and inadequate understanding of implementation processes can lead to loss of critical, experiential knowledge related to what works to prevent suicide in real world settings., Competing Interests: Conflict of interest The authors declare no competing interests., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Currently, there is no comprehensive study focused on identifying what is needed to support ongoing participation within the suicide prevention lived experience workforce (LEW). It is unclear what specific factors may impede or support ongoing participation in the LEW. The aim of this study was to explore the experiences of suicide prevention LEW in terms of its sustainability., Method: A qualitative interview method was utilised, with a purposive sample of participants who had engaged in the LEW for at least 12 months. The sample comprised 13 individuals (nine females, four males) who engaged in multiple LEW roles, with over half (54%) working in the LEW for more than 5 years. Data were analysed using thematic analysis., Results: Five main themes were identified: support, passion, personal impact, training, and work diversity. Each theme offers perspectives about the challenges participants face within the suicide prevention LEW., Conclusion: Challenges faced are both similar to those found in the broader MH sector and unique to suicide prevention. Findings suggest that managing expectations of the LEW is important and can inform the creation of guidelines for a supported and sustainable suicide prevention LEW.

It has been argued that effective action towards addressing a complex concern such as suicide requires a combination of evidence-based strategies. While these complex public health approaches have recently gained importance, little is known about their characteristics and what contributes to their complexity. The use of interchangeable terms such as multilevel , multicomponent , community based , and inconsistent definitions of these approaches creates confusion around what it is and what it is not. In practice, this disorder is reflected in a substantial variation in the design, implementation, and evaluation of complex approaches in suicide research. While it is impossible to resolve all existing inconsistencies in terminology, this review explores a range of terms and definitions to connote complex interventions . It aims to unpack multiple meanings of these terms and their diverse usage in suicide literature. The potential implications of this fluidity and plausible pathways to make sense of this complexity for suicide research are also discussed. With a shared understanding of what constitutes a complex intervention , we can expect to see an improved representation of the real-world complexities in our efforts to address suicide. This common language can also contribute toward quality implementation and dissemination and thereby advance our understanding of complex interventions.

There is evidence indicating that traditionally male-dominated occupations are associated with greater risk of suicide. In Australia, MATES in Construction was developed as an occupational health initiative to prevent suicides in the industry. The program has recently been applied to the energy industry; however, little is known regarding exposure to suicide and suicide prevention interventions in this sector. The study aimed to examine the effectiveness of MATES in Energy general awareness training (GAT), and estimate the prevalence of recent suicidal ideation and exposure to suicidal behaviors in workers. A before and after design was used to examine the effectiveness of GAT training. Data were collected from 4887 participants undertaking GAT training at energy sites across Queensland, Australia. In total, 2% (97) of participants reported recent suicidal thoughts, 65% of participants reported they had known someone who had attempted suicide, and 69% had known someone who died by suicide. Significant improvements were found on all suicide literacy items after GAT training. Younger people were more likely to be positively affected by the intervention. The results indicate that the MATES in Energy program is successfully transitioning from the construction industry, and offers the first empirically supported suicide intervention tailored to the energy sector.

Purpose: Rural communities in Australia have an elevated risk of suicide. The aim of the current study was to evaluate a well-being and suicide prevention education workshop, SCARF (Suspect, Connect, Ask, Refer, Follow-Up) developed for Australian farming and rural communities., Methods: The SCARF program was delivered to 14 groups, a convenience sample including frontline agricultural workers and farmers from New South Wales. The Literacy of Suicide Scale, Stigma of Suicide Scale, and items assessing confidence to assist others were administered immediately before and after the workshop, and at 3-month follow-up. The Warwick Edinburgh Mental Wellbeing Scale was given immediately before and at 3-month follow-up. In total, 255 agreed to participate in the study, with 127 completing 3-month follow-up. Data were analyzed using linear mixed-effects regression., Findings: There was a significant increase in suicide literacy and confidence to assist others immediately after the workshop, which remained significant at 3-month follow-up. Mental well-being significantly improved at 3-month follow-up., Conclusion: The SCARF program is unique for its brevity, cultural specificity, focus on health, and incorporation of the biopsycho-ecological model and the Interpersonal Theory of Suicide. It represents a useful program for Australian farming and rural communities to improve mental well-being, suicide literacy, and confidence to recognize and respond to suicidality., (© 2019 National Rural Health Association.)

As part of a suite of early intervention training and support services, Mates in Construction (MATES) provide two general awareness programs to promote mental health and suicide awareness and encourage help-offering and help-seeking in construction workers. General awareness training (GAT) is a one-hour session delivered to all construction workers on large to medium worksites, while MATES awareness training (MAT) maintains similar content but is of shorter duration and delivered informally to small workplaces. This study aimed to compare the effectiveness of the two programs using a before, after and follow-up design. Construction workers undertaking MAT or GAT training completed a short survey before and after their training and again at follow-up. Linear mixed-effect modelling indicated that GAT and MAT training provided similar results in improving suicide awareness and help-seeking intentions. Some variables showed a significant increase from pre-intervention to the three-month follow-up, indicating the long-term impact of some aspects of the training. The findings demonstrating the effectiveness of MAT training have important implications for MATES, as the training can be delivered to much smaller workplaces, making the program more widely available to the construction industry., Competing Interests: The authors declare no conflict of interest. Jorgen Gullestrup is employed as the Chief Executive Officer (Queensland and Northern Territory) of Mates in Construction.

The Mates in Construction (MATES) program was developed to address the issue of high suicide rates among males in the Australian construction industry. The program delivers early intervention training and support to construction workers. This mixed-methods study aimed to (1) examine the effectiveness of training for MATES connectors and (2) examine the barriers, motivations and pathways to help-seeking and help-offering for both MATES connectors and clients. A total of 104 volunteers completed a short survey before and after connector training sessions. Quantitative data analysis showed significant increases in connectors' self-reported suicide awareness, and willingness to offer help to workmates and seek help themselves. For the qualitative component, 27 connectors and clients participated in focus groups and individual interviews. Thematic analysis identified six themes from the connectors' data: awareness, skills and confidence; removing stigma; making a difference; simplicity of the model; understanding the industry; and visibility, camaraderie and passion. For clients, three key themes emerged: barriers and pathways to help-seeking; speaking the same language; and flow-on effects. The results provide evidence for the effectiveness of connector training and indicate that MATES's peer support model is enabling workers to overcome traditional barriers and attitudes to seeking and offering help.

Given the important role teachers play as gatekeepers in school suicide prevention, this study explored teachers' perspectives on what should be done to improve current suicide prevention efforts. The study, in Queensland, Australia, was part of a large-scale survey examining teachers' knowledge, attitudes and experience of suicidality. One hundred and fifteen teachers responded to an online survey question regarding their views on the requirements for school suicide prevention. Qualitative analysis identified five themes from teachers' responses: awareness and stigma reduction, support services for students, education and training, bullying and the role of social media. The results of this study provide some profound insights into teachers' perspectives on suicide and highlight the critical need for improved suicide prevention efforts in schools.

Background: The importance and value of involvement of people with lived experience of suicide has been recognized in suicide research and prevention. Nonetheless, clear guidance on research collaboration and co-production is lacking. This study aimed to address this gap by developing a set of guidelines on active involvement of people with lived experience of suicide in suicide studies., i.e., conducting research with or by people with lived experience, rather than to, about or for them. Methods: The Delphi method was used to determine statements on best practice for the active involvement of people with lived experience of suicide in suicide research. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing qualitative data from a recent related study conducted by the authors. Two expert panels: people with lived experience of suicide (n = 44) and suicide researchers (n = 29) rated statements over three rounds of an online survey. Statements endorsed by at least 80% of panellists of each panel were included in the guidelines. Results: Panellists endorsed 96 out of 126 statements in 17 sections covering the full research cycle from deciding on the research question and securing funding, to conducting research and disseminating and implementing outcomes. Overall, there was a substantial level of agreement between the two panels regarding support from research institutions, collaboration and co-production, communication and shared decision making, conducting research, self-care, acknowledgment, and dissemination and implementation. However, panels also disagreed on specific statements regarding representativeness and diversity, managing expectations, time and budgeting, training, and self-disclosure. Conclusions: This study identified consensus recommendations on active involvement of people with lived experience of suicide in suicide research, including co-production. Support from research institutions and funders, and training on co-production for researchers and people with lived experience, are needed for successful implementation and uptake of the guidelines. [ABSTRACT FROM AUTHOR]

Objectives Working in high-stress and male-dominated occupations is associated with an elevated risk of suicide. The current study sought to conduct the first systematic literature review and meta-analysis aimed at determining suicide risk across the diverse, high pressure and male-dominated transport industry (commercial aviation, merchant seafaring, transit/driving) as compared to the general/employed population. Methods Searches of PubMed/Medline, Scopus and PsycINFO databases were conducted without date restriction until March 2021. Studies were included if they were written in English, were peer reviewed, and presented primary observational research data. Studies referring exclusively to suicidal ideation, suicide attempts, selfharm, and/or accidents were excluded. Results Following deletion of duplicates and non-English titles, a total of 4201 titles/abstracts were screened and 92 full-texts were read against inclusion/exclusion criteria. The final included sample consisted of 23 articles (16 used for meta-analysis). Results from the meta-analysis indicated that transport workers had a significantly elevated risk for suicide as compared to the general/employed population. Results were consistent across sensitivity analyses, and there was some variation across subgroup analyses. Conclusions Overall, we found transport workers had a significantly higher risk for suicide than the general/employed population, and this appeared to be driven by the association for those working in merchant seafaring/maritime occupations. The findings are discussed in relation to an identified need for the development, implementation, and evaluation of tailored workplace suicide prevention strategies for transport industry workers. [ABSTRACT FROM AUTHOR]

Farmers and farm workers have been recognized as a group at high risk of suicide in Australia. This study aims to identify and better understand environmental factors associated with suicide among Australian farmers and farm workers. Qualitative analysis was undertaken in accordance with the Consolidated Criteria for Reporting Qualitative Research. Male and female focus groups were conducted separately with people who lived or worked on a farm in six farming communities. Qualitative analyses showed that a number of environmental influences may contribute to the increased risk of suicide: extreme climatic events; isolation; service availability; access to, and frequent use of firearms; death and suffering of animals; government and legislation; technology; and property values. Both the physical and socio-cultural environments in which farmers operate appear to contribute to farmer suicide and need to be considered in suicide prevention. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethods and materialsResultsConclusionEffective suicide prevention interventions are infrequently translated into practice and policy. One way to bridge this gap is to understand the influence of theoretical determinants on intervention delivery, adoption, and sustainment and lessons learned. This study aimed to examine barriers, facilitators and lessons learned from implementing complex suicide prevention interventions across the world.This study was a secondary analysis of a systematic review of complex suicide prevention interventions, following updated PRISMA guidelines. English published records and grey literature between 1990 and 2022 were searched on PubMed, CINAHL, PsycINFO, ProQuest, SCOPUS and CENTRAL. Related reports were organized into clusters. Data was extracted from clusters of reports on interventions and were mapped using the updated Consolidated Framework for Implementation Research.The most frequently-reported barriers were reported within the intervention setting and were related to the perceived appropriateness of interventions within settings; shared norms, beliefs; and maintaining formal and informal networks and connections. The most frequently reported facilitators concerned individuals’ motivation, capability/capacity, and felt need. Lessons learned focused on the importance of tailoring the intervention, responding to contextual needs and the importance of community engagement throughout the process.This study emphasizes the importance of documenting and analyzing important influences on implementation. The complex interplay between the contextual determinants and implementation is discussed. These findings contribute to a better understanding of barriers and facilitators salient for implementation of complex suicide prevention interventions. [ABSTRACT FROM AUTHOR]