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Introduction: Rural and remote Australia has long been recognised as an area with reduced help-seeking for mental health concerns and an increased suicide mortality. The current study aimed to investigate the differences between help-seeking intentions and predictors between different locations across Australia to better understand the barriers to seeking help for rural residents., Methods: An anonymous online survey measuring attitudes, stoicism, help-seeking intentions and demographics was conducted through various channels across Australia. Differences between locations and relationships between variables of interest were analysed using multiple regression and mediation analysis., Results: In total, 471 participants were included in the analysis, the majority residing in outer regional areas (37.4%), followed by inner regional areas (29.9%), major cities (18.3%), remote areas (12.3%) and very remote areas (2.1%). Location, along with attitudes and stoicism, were predictors of help-seeking. A novel mediation model revealed that attitudes partially mediated the association between stoicism and lower help-seeking intentions for both rural and urban participants., Conclusion: Findings from this study extend knowledge of what differentiates people who are willing from those who are not willing to seek help for a mental health concern or suicidal ideation, by their living location. The findings also suggest practical implications for clinical intervention and community prevention that could assist improving help-seeking for rural Australians in the future.

Background: Gap Park in Sydney, Australia has historically been recognised as a suicide jumping site. In 2010-2011 the Gap Park Masterplan initiative implemented a series of suicide prevention measures. This study applied a mixed-methods design to evaluate the effectiveness of the Masterplan in reducing suicides., Methods: Data from the Australian National Coronial Information System (NCIS) was examined to compare suicides at Gap Park before and after the Masterplan was implemented. This was complemented with qualitative data from interviews with police officers who respond to suicidal behaviours at Gap Park., Findings: Joinpoint analysis of NCIS data showed a non-significant upward trend in jumping suicides during the study period. A significant upward trend in suicides was seen for females before the implementation of the Masterplan (2000-2010), followed by a significant downward trend from the implementation period onwards (2010-2016) for females: however, a non-significant upward trend for males was observed. Qualitative analysis of police interviews identified six key themes: romanticism and attraction at hotspots, profiles and behavioural patterns of suicidal individuals, responding to a person in a suicidal crisis, repeat attempts, means restriction, and personal impacts on police officers., Interpretation: The mixed-method study provided important insights, suggesting the Gap Park Masterplan has contributed to a reduction in female, but not in male jumping suicides. Further qualitative information from police officers suggested that the safety barriers were not difficult to climb, and may be more of a visual or psychological barrier. However, the effectiveness of CCTV and alarms in the detection and location of suicide attempters was highlighted., Funding: Lifeline Research Foundation., Competing Interests: We declare no competing interests., (© 2020 Published by Elsevier Ltd.)

Background: Limited information is available about suicidal behavior in the Pacific Islands. Forty percent of the New Caledonian population is indigenous Kanak; insights into the characteristics of suicide deaths in this population compared to other ethnic groups would be valuable. The aim of this paper is to deepen our understanding of the cultural underpinnings of suicide in New Caledonia by presenting the results of the WHO/START psychological autopsy study., Method: A case-series psychological autopsy study was conducted based on medical, police files, and interviews with relatives of 52 individuals who died by suicide in 2014 and 2015 in New Caledonia., Results: Kanak indigenous individuals represented more than half of suicides. Prevalence of mental disorders was identified in 62% of suicide decedents; a previous suicide attempt was frequent (37% of cases). A serious argument with a partner was the most prevalent life event (60%). Few warning signs were present among young people and Kanak in general., Conclusion: Comparison with information on the general population suggests indigenous Kanak are more vulnerable and that having a mental health disorder plays an important role in suicide. Violent arguments with a partner could also be a major risk factor. Traditional protective factors (being employed, living with their family or partner, religion) appeared to have limited effect on suicide. Mental health promotion, prevention, and care should be prioritized. Prevention strategies, including domestic violence prevention are recommended in New Caledonia. Further research is needed to better identify young and Kanak subjects at risk of suicide., (Copyright © 2019. Published by Elsevier B.V.)

Introduction: While suicide bereavement has been assumed to be different from bereavement following death by other modes, a number of studies have reported that there are several similarities, particularly for violent deaths. The aims of the current study are to test, using confirmatory factor analysis, the factor structure of Grief Experience Questionnaire (GEQ) that has been proposed in other studies; and to compare short term grief reactions, mental health, and suicidality six-months after bereavement in close family members bereaved by suicide versus sudden death., Methods: Participants were 142 adults who were bereaved following a suicide and 63 who were bereaved following the sudden death of a family member. Data were collected six-months after the death., Results: Analyses did not show good fits for the factor structures proposed for the GEQ in earlier studies. However, a relatively good fit was found for an 8-factor version of the originally proposed GEQ. Bereavement type (suicide vs. sudden death) significantly predicted rejection, somatic reactions, stigmatisation, responsibility and shame on the GEQ, after adjusting for kinship type, gender, age, pre-bereavement diagnosis of mental illness and self-harm behaviours of both the deceased and the bereaved, and current mental health and suicidal ideation of the bereaved., Limitations: Different recruitment methods were used and response rates were relatively low., Conclusions: The new knowledge of bereaved experiences specific to suicide loss at six-months post death, should be channelled into determining the most practical and satisfactory ways to alleviate the impacts of these potentially changeable states of experience., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The aim of this study was to examine (1) suicide trends by most prevalent methods in Queensland, Australia, during 2000-2015, and (2) characteristics of people by choice of suicide method in 2000-2013. Data were obtained from the Queensland Suicide Register, which includes police and toxicology reports, post-mortem autopsy and Coroner's findings. Poisson and Joinpoint regression were used to study the first aim, and uni-variate and multi-variate logistic regression analyses were applied to investigate the second aim. Suicide method trends showed a significant increase in hanging for both sexes and poisoning with drugs for females, while there was a decline for poisoning by other means for both sexes, and 'other methods' decreased for males. Changes in the trends have altered the order of suicide methods, especially in males. Analyses of 8140 suicides were composed by the choice of method, distinguishable profiles by their demographic, clinical and social characteristics, such as having mental or physical illness or different recent life stressors were identified. This suggests that socio-cultural acceptability, and availability are the key drivers in the choice of suicide methods. Continuing increases in hanging is a big challenge in suicide prevention due to its lethality, easy realisation and its increasing acceptability., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Introduction: People who die by suicide have a higher risk of an alcohol-use disorder (AUD) at the time of death. The present study aims to compare 1) suicide cases with and without AUD, and 2) suicide and sudden-death controls with AUD., Methods: The psychological autopsy method was utilized to investigate suicide and sudden death in Australia (QLD and NSW). Initial information was gathered from coroners' offices. Potential informants were approached and semi-structured interviews were conducted. Univariate and multivariate logistic regression were applied., Results: People with AUD who died by suicide were significantly more likely to have another substance-use disorder, history of suicide attempt, recent serious arguments with spouse/partner and other family members, been unfaithful to partner/spouse, be victims of a crime, and were less likely to be from a non-English speaking background. They were also younger and had higher levels of aggression compared to non-AUD suicides. AUD suicides were more likely to have mood disorders, previous suicide attempt, expressing hopelessness, higher scores in aggression towards self, romantic relationship breakup, and serious arguments with other family members than AUD sudden deaths. Aggressive behavior, having another substance-use disorder, and history of serious arguments with family members remained significant in the final model comparing suicides with and without AUD., Conclusion: Our findings support that aggressive behavior, comorbidity with other psychiatric disorders as predisposing factors, and recent interpersonal conflicts such as breakup and family conflicts can trigger suicide in people with AUD. There is a need for proper diagnosis, risk assessment, and treatment in suicidal people with AUD., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Given the continued paucity of research into suicide in lesbian and gay (LG) people, there is a need to investigate the characteristics of those LG suicides that are able to be identified. The aim of this article was to analyze pathways to suicide in lesbian and gay individuals by way of life charts. Data were gathered through of 24 psychological autopsy interviews with next-of-kin of an LG person who had died by suicide. The female (n = 5) and male (n = 19) cases in this study clustered into younger and older suicides. The defining feature of the younger suicides was lack of acceptance by family and, to a lesser extent, self, and that of the older suicides was romantic relationship conflict, although this was also common in younger suicides. There appears to have been, furthermore, an accumulation of risk factors, particularly in the period prior to death where these specific risk factors combined with other life stressors, such as work problems. Initiatives to reduce stigma around diversity in sexuality and to support families and young people through the "coming out" process as well as services designed to assist those experiencing problems in same-sex relationships, in particular, would appear to be the most relevant within the trajectories presented.

There are notable differences in suicide methods between countries. The aim of this paper is to analyse and describe suicide methods in children and adolescents aged 10-19 years in different countries/territories worldwide. Suicide data by ICD-10 X codes were obtained from the WHO Mortality Database and population data from the World Bank. In total, 101 countries or territories, have data at least for 5 years in 2000-2009. Cluster analysis by suicide methods was performed for countries/territories with at least 10 suicide cases separately by gender (74 for males and 71 for females) in 2000-2009. The most frequent suicide method was hanging, followed by poisoning by pesticides for females and firearms for males. Cluster analyses of similarities in the country/territory level suicide method patterns by gender identified four clusters for both gender. Hanging and poisoning by pesticides defined the clusters of countries/territories by their suicide patterns in youth for both genders. In addition, a mixed method and a jumping from height cluster were identified for females and two mixed method clusters for males. A number of geographical similarities were observed. Overall, the patterns of suicide methods in children and adolescents reflect lethality, availability and acceptability of suicide means similarly to country specific patterns of all ages. Means restriction has very good potential in preventing youth suicides in different countries. It is also crucial to consider cognitive availability influenced by sensationalised media reporting and/or provision of technical details about specific methods.

Background: The impact of suicide of adolescents is devastating, yet little is known about the distressing impact for teachers. The aim of this study therefore is to explore the impact student suicide on teachers' personal and professional lives., Methods: A cross-sectional anonymous online survey of primary and secondary school teachers was conducted in Australia. The Impact of Event Scale - Revised, questions about personal and professional impact, help seeking, perceived needs and experiences after student's suicide were included in the analysis., Results: In total, 229 teachers commenced the questionnaire, with 138 (60.3%) completing the full questionnaire. Questions about exposure to students' suicide were completed by 145 teachers (63.3%). In total, 35.9% (n=52) were exposed to at least the suicide of one student (two or more: 54.8%). The most recent suicide of a student had (some or great) impact on the personal life of 76% of teachers and on the professional life of 85.7%. Impact on personal life was significantly higher for female teachers. The most frequent source for help seeking was family or partner (65.3%); use of professional help was also reported, with the school counsellor being the most frequent (30.6%). Following the most recent suicide of a student, 27.1% of teachers exposed to suicide felt that they needed more support., Limitations: The potential for selection bias through the use of an online survey, and the relatively small sample., Conclusion: The study showed high levels of distress among teachers after exposure to a student's suicide and greater need for help than that obtained., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Purpose: The aim of the current analysis is to analyze suicide rates in adolescents aged 15-19 years in decades between 1990 and 2009 worldwide., Methods: Suicide data were obtained from the World Health Organization Mortality Database and population data from the World Bank Data set. In total, 81 countries or territories, having data at least for 5 years in 1990-1999 and in 2000-2009, were included in the analysis. Additional analysis for regional trends with 57 countries was performed., Results: Over the decades considered, analysis showed a declining trend in the overall suicide rate for males from 10.30 to 9.51 per 100,000 (p = .076), and for females from 4.39 to 4.18 (p = .472). The average suicide rate showed a significant decline for both genders in Europe, dropping from 13.13 to 10.93 (p = .001) in males and from 3.88 to 3.34 in females (p = .038). There was a significant increase in South American countries for males, from 7.36 to 11.47 (p = .016), and a close to significant rise for females, from 5.59 to 7.98 (p = .053). Although other world regions did not show significant trends, there were several significant changes at country level., Conclusions: Reasons behind the decrease in Western countries could potentially be related to the overall improvements in global health; the possible contribution of suicide prevention activities remains unclear. Increases in several South American countries might be related to economic recession and its impact on adolescents from diverse cultural backgrounds, and partly also to improvements in mortality registration., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: This is the first research article examining non-fatal suicidal behaviours (NFSB) in French Polynesia. The study was conducted in the frames of the WHO/START Study in 2008-2010. The main objective of the investigation was to obtain reliable data in order to develop evidence-based suicide prevention strategies., Method: Interviews with people presenting with NFSB at the Emergency Department (ED) of the French Polynesia Hospital (CHPF) were conducted by emergency and psychiatry departments' staff examining socio-demographic and clinical information and motives triggering suicidal behaviour. Odds ratios and rate ratios with 95% confidence intervals were calculated., Results: There were 556 presentations of NFSB by 515 persons at the ED of CHPF (ratio 1.08) with the average rate of 75 per 100,000 for those treated in the hospital. An estimate of cases occurring in remote islands might bring the rate for the whole French Polynesia around 94 per 100,000. NFSB was more prevalent in females; rates for both genders were highest in the age group 25-35 years and 15-24 years. The main suicide method was drug poisoning by psychotropic drugs. The most frequent psychiatric disorder was mood disorder (45.3%); however, 26% of subjects had no 'major' psychiatric disorders, with 14.5% without a psychiatric diagnosis or only reactive disorders (F43-11.7%). There was a high prevalence of previous NFSB (52.1%)., Limitations: Study includes only NFSB seeking medical help from the biggest hospital in the country., Conclusion: Suicide prevention activities specific to the findings and the socio-cultural context of French Polynesia should be considered., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: With the exception of the United States, in recent years suicide rates have been declining in most western countries. Notoriously, suicide rates fluctuate - especially in males - in response to a range of socio-political and environmental factors, some of them difficult to identify. Our aim was to obtain an updated profile of main commonalities in suicide cases of Queensland residents between 2002 and 2011 to inform prevention strategies., Methods: Data were obtained from the Queensland Suicide Register (QSR), including police and toxicology reports, post-mortem autopsy and Coroner's findings. Data are crosschecked with records from the National Coronial Information System. Age-standardised rates (ASR) of suicide, Poisson regression and Chi(2) tests are presented., Results: A total of 5752 suicides by Queensland residents was registered between 2002 and 2011; 76.9% by males and 23.1% by females. The average ASR was 14.3 per 100,000, with a significant decrease between 2002 and 2011. Rates declined significantly in males, not in females. On average, rates were 3.41-times higher in males. ASR for Aboriginal and Torres Strait Islander peoples was significantly higher than for other Australians. Overall, male suicide rates were particularly high in remote areas, as well as in the most disadvantaged ones. One third of suicide cases presented history of previous suicidal behaviour, and half a detected and treated mental disorder. Hanging was the most common method., Conclusions: Suicide rates have declined in Queensland, Australia. It is problematic to say if this was due to suicide prevention programs or other factors., (Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Objective: Suicide rates among Indigenous Australian children are higher than for other Australian children. The current study aimed to identify factors associated with Indigenous child suicide when compared to other Australian children., Methods: Using the Queensland Suicide Register, suicides in Indigenous children (10-14 years) and other Australian children in the same age band were compared., Results: Between 2000 and 2010, 45 child suicides were recorded: 21 of Indigenous children and 24 of other Australian children. This corresponded to a suicide rate of 10.15 suicides per 100,000 for Indigenous children - 12.63 times higher than the suicide rate for other Australian children (0.80 per 100,000). Hanging was the predominant method used by all children. Indigenous children were significantly more likely to suicide outside the home, to be living outside the parental home at time of death, and be living in remote or very remote areas. Indigenous children were found to consume alcohol more frequently before suicide, compared to other Australian children. Current and past treatments of psychiatric disorders were significantly less common among Indigenous children compared to other Australian children., Conclusions: Western conceptualisation of mental illness may not adequately embody Indigenous people's holistic perspective regarding mental health. Further development of culturally appropriate suicide prevention activities for Aboriginal and Torres Strait Islander children is required., (© 2014 Public Health Association of Australia.)

Personality traits were examined using the NEO Five-Factor Inventory-Revised in an Australian psychological autopsy study involving 259 suicide deaths and 181 sudden death controls aged 35 years and over. Interviews included the Structured Clinical Interview for DSM-IV to determine the presence of psychiatric disorder. Personality traits of suicide deaths differed significantly from those of controls, scoring higher in the Neuroticism and Openness to Experience domains and lower on the Agreeableness and Extraversion domains. These findings varied with the presence of psychiatric disorder and by age. High Neuroticism scores were the most consistent finding in people who died by suicide, although these scores decreased in older suicides., (© 2013 The American Association of Suicidology.)

Aim: This study aims to examine contacts with different health professionals in the three months prior to death in suicide cases compared to sudden death controls; and, to analyse contacts with health professionals among people who died by suicide having a diagnosable mental health disorder at the time of suicide compared to those who did not have such a diagnosis within four major groups of conditions., Methods: The psychological autopsy method was utilised to investigate suicides of individuals over the age of 35years. A case-control study design was applied using sudden death cases as controls. Odds ratios with a 95% confidence interval were calculated., Results: In total, 261 suicides and 182 sudden deaths were involved. In terms of contacts during the last three months prior to death, 76.9% of suicides and 81.9% of sudden deaths visited a general practitioner (GP). Persons who died by suicide had significantly more frequently contacts with mental health professionals than sudden death controls did. People with a diagnosable mental health disorder at the time of suicide attended GP surgeries with approximately the same frequency of people without a diagnosis at GP level., Conclusion: Similarly, approximately 90% of people who die by suicide and by sudden death seek for help from health care system, mainly from GPs in three months prior to their death. With reference to health care contacts, people who had or did not have a diagnosable psychiatric disorder are not distinguishable at the GP surgery level., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Aim: To investigate the treatment priority given to self-harmers presenting to a hospital emergency department (ED) in Queensland, Australia, over the period 2005-2010., Methods: The main outcome measure of this study was the treatment priority given to persons presenting with suicide ideation and communication (SIC) or self-harming behaviour. Treatment priority was measured using the Australasian Triage Scale, which ranks patients from 1 (in need of immediate treatment) to 5 (assessment and treatment to start within 120 min). Ordered logistic regression was used to assess the broad demographic and treatment-related factors associated with more urgent triage categories and to investigate which methods of non-fatal suicidal behaviour (NFSB) were prioritised as most urgent., Results: Most cases of NFSB were between 15 and 34 years. A larger proportion of persons presenting for SIC were aged 35 to 44 years. Over 50% of male presentations and 38% of female presentations were for SIC. Those cases prioritised as being more urgent had significantly greater odds of being older, presented after an act of self-harm rather than SIC, and had used multiple methods of NFSB. These individuals also had greater odds of being male and having made past presentations for SIC or NFSB. Among males, those presenting after ingestion of drugs had the greatest odds of receiving immediate attention compared to SIC. "Cutters" were considered as the least "urgent" subjects, and had a greatest risk of waiting 60 to 120 min for treatment compared to suicide ideators. Among females, those presenting with chemicals, poisons and gases had the greatest odds of receiving immediate attention compared to SIC. Females who presenting after cutting themselves had lower odds of receiving immediate treatment than those who presented with SIC., Conclusion: ED staff seems to judge the urgency of cases based on demographic factors such as age and gender, as well as method of NFSB.

Background: Various consequences including suicidal behaviours can arise in the aftermath of natural disasters. The aim of the present review was to systematically analyse the existing literature on the potential impact of natural disasters on suicidal behaviours., Methods: A systematic search of English-language articles indexed in electronic databases was conducted. The current review covers 42 papers containing empirical analyses of the relationship between natural disasters and suicidal behaviours., Results: In total, 19 papers analysed suicide mortality and 23 non-fatal suicidal behaviours. The effects of earthquakes on suicidal behaviours are the most frequently studied among natural disasters (n=20), followed by hurricanes (n=11). Further, there were four papers about tsunamis, three about floods, three about heat waves and drought, and one investigating the effects of multiple natural disasters. The studies show different directions in suicide mortality following natural disasters. Nevertheless, there seems to be a drop in non-fatal suicidal behaviours in the initial post-disaster period, which has been referred to as the 'honeymoon' phase. A delayed increase in suicidal behaviours has been reported in some studies. However, other factors increasing the risk of suicidal behaviours after natural disasters have been reported, such as previous and current mental health problems. Furthermore, contributing factors, such as economic conditions, should also be considered., Limitations: The exclusion of non-English articles., Conclusions: In light of the various methodological limitations observed, there is a need for further studies using proper designs. Mental health and suicidal behaviours should continue to be monitored for several years after the disaster., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: There is a lack of understanding of how the changing nature of the separation process impacts on suicidality., Aims: This paper aims to identify factors contributing to fluctuations in suicidality during the process of marital/de facto separation along a 6-month follow-up., Method: Separated persons who had contacted relationship-counselling services, help-line services, and variety of support and self-help groups were asked to participate in the first assessment. A 'Follow-Up Questionnaire' was sent 6 months later. Participants were required to be 18 years or older and separated from their married/de facto partner within the previous 18 months but not yet divorced., Results: Overall, in the first assessment, separated females presented lower levels of suicidality than males. During the follow-up suicidality decreased. There were some gender differences in terms of predictors of changes in suicidality. Separated males who showed an increase or stability in suicidality were more affected by stressful experiences such as legal negotiations on obtaining a divorce, feelings of loss and loneliness, loss of social networks and financial difficulties than males who were not suicidal in either assessment. Separated males and females who remained suicidal were more likely to report different mental and physical illnesses., Limitations: Relatively low response rates of the follow-up (60%) limited our statistical analyses as some of the groups were too small and did not enable modelling., Conclusions: Suicidality decreased, which seems to indicate that individuals adjusted to their new life circumstances. However, persons whose suicidality remained or increased reported more frequently stressful life events, physical and mental illnesses., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Purpose: This study analysed suicide rates among first-generation immigrants in Australia from 1974 to 2006, and compared their suicide risks against the Australian-born population. It also examined the associations between the suicide rates of immigrants from 23 selected countries of birth during 2001-2006, and in their home countries., Method: Age-standardised suicide rates (15+ years) and rate ratios, with a 95 % confidence interval, during 1974-2006 were calculated for country of birth (COB) groups. Spearman's rank correlation coefficient was calculated between COB-specific immigrant suicide rates during 2001-2006 in Australia and in their homelands., Results: Suicide rates showed a decreasing time-trend among all COB groups for both genders in Australia. The lowest suicide rates were found during 2004-2006, compared to other year groups. Throughout the study period, males born in Eastern, Northern and Western Europe and New Zealand had the highest suicide rates in Australia. For females, the highest rates were among those born in Western Europe and the UK (including Ireland). Male and female migrants born in North Africa and the Middle East, Southern and Central Asia and South East Asia showed the lowest suicide rates. There was a significant correlation between male immigrant suicide rates by COB and the rates of their home countries., Conclusion: The patterns of suicide rates in immigrants were influenced by the social and cultural norms of their COB. The overall decrease in suicide risk among immigrants was particularly evident in males.

The influence of feelings of shame originating from marital breakdown on suicidality is examined. The role of mental health problems as probable mediating factors is also considered. Internalized shame, state (related to separation) shame, and mental health problems were significantly correlated with the score for suicidality during separation in both genders. Tested structural equation model indicated that internalized shame was not directly linked to suicidality, but was mediated either by state shame or mental health problems in males in the context of separation. Our findings seem to indicate that separated males are more vulnerable to the experience of state shame in the context of separation, which might lead to the development of suicidality., (© 2011 The American Association of Suicidology.)