Suicide is a leading cause of death among youth worldwide. The purpose of the current review was to examine recent cross-national trends in suicide mortality rates among 10- to 19-year-olds. This study extracted suicide mortality data from the World Health Organization's (WHO) Mortality Database for the most recent year (since 2010) from any country with available high-quality data (as defined by the WHO's guidelines). Data on access to lethal means (firearms, railways) and measures of economic quality (World Bank Income Group) and inequality (Gini coefficients) were obtained from publicly available data sources. Cross-national suicide mortality rates in youth were heterogeneous. The pooled estimate across all ages, sexes, and countries was 3.77/100,000 people. The highest suicide rates were found in Estonia, New Zealand, and Uzbekistan. Suicide rates were higher among older compared with younger adolescents and higher among males than females. The most common suicide methods were hanging/suffocation and jumping/lying in front of a moving object or jumping from a height. Firearm and railway access were related to suicide deaths by firearms and jumping/lying, respectively. Economic quality and inequality were not related to overall suicide mortality rates. However, economic inequality was correlated with a higher ratio of male:female suicides. This study provides a recent update of cross-national suicide trends in adolescents. Findings replicate prior patterns related to age, sex, geographic region, and common suicide methods. New to this review are findings relating suicide method accessibility to suicide mortality rates and the significant association between income inequality and the ratio of male:female suicide. Future research directions include expanding the worldwide coverage to more low- and middle-income countries, examining demographic groupings beyond binary sex and to race/ethnicity within countries, and clarifying factors that account for cross-national differences in suicide trends.
The number of college students who need mental health treatment outpaces the resources available to counseling centers to provide these needed services, presenting a need for low-cost, scalable interventions for college populations. We conducted a pilot effectiveness trial of a scalable treatment package that consisted of a single (telehealth) workshop plus a companion app that provided ecological momentary intervention. Participants (n=177) received a workshop provided by counseling center staff and trainees. We were interested in (1) engagement with the app, (2) acceptability of the treatment, and (3) initial effectiveness of the treatment. Regarding engagement, we found that participants preferred two reminder prompts per day and identified two key inflection points where engagement fluctuated: at day 15, where just over half of the sample practiced a skill on the app at least once during the day and at day 41, where just over one third of people practiced a skill on the app each day. Regarding acceptability, students generally reported positive attitudes about the single-session workshop and app, but also noted that the content and assessments in the app needed to be more dynamic to improve how engaging it is. Regarding effectiveness, we found that about 75% of the sample experienced a significant reduction in negative affect from pre- to post-ecological momentary intervention. The results of this study are promising in terms of providing initial support for this novel treatment package and provide useful information for researchers planning to develop and test similar interventions.
This study was a multistage process of recruiting participants through Reddit with the intent of increasing data integrity when facing an infiltration of Internet bots. Approaches to increase data integrity centered around preventing the occurrence of Internet bots from the onset and increasing the ability to identify Internet bot responses. We attempted to detect bots in a study focused on understanding social factors related to autism and suicide risk. Four recruitment rounds occurred through Reddit on mental health-related subreddits, with one post made on each subreddit per recruitment round. We found high presence of bots in the initial rounds-indeed, using location data, one third of the total responses (33.4 percent; 118/353) came from just eight locations (i.e., 4.7 percent of all locations). The proportion of detected bots was significantly different across the rounds of recruitment (χ2 = 150.22, df = 3, p < 0.001). In round 4, language advertising compensation was removed from recruitment posts. This round had significantly lower proportions of detected bots compared with round 1 (χ2 = 33.01, df = 1, p < 0.001), round 2 (χ2 = 129.14, df = 1, p < 0.001), and round 3 (χ2 = 46.6, df = 1, p < 0.001). Through a multistage recruitment process, we were able to increase the integrity of our collected data, as determined by a low percentage of fraudulent responses. Only once we removed advertisement of compensation in recruitment posts, did we see a significant decrease in the quantity and percentage of Internet bot responses. This multistage recruitment study provides valuable information regarding how to adapt when an online survey study is infiltrated with Internet bots.
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Self-injurious behavior (e.g., nonsuicidal self-injury, suicide attempts) is a serious public health concern. One potentially important but understudied predictor of nonsuicidal and suicidal self-injury involves the behavioral inhibition and activation system (BIS/BAS).The goal of the current study was to examine the relationship between nonsuicidal and suicidal self-injury and BIS/BAS, and to consider the influence of related variables in the relationship. Examination through this framework allowed us to consider BIS and BAS as potential unique risk factors of self-injury.After examining the relationship between nonsuicidal and suicidal self-injury and BIS/BAS among 1,912 participants, we used propensity scores to match participants' propensity for nonsuicidal self-injury and suicide attempts based on demographic variables (e.g., gender, age) and related risk factors (e.g., anxiety, depressive symptomology, impulsivity, and substance use problems).Participants who reported nonsuicidal self-injury or attempted suicide scored higher on BIS and BAS compared with those without a history of these behaviors. After matching procedures, however, the only group difference found was on BIS between those with and without a history of nonsuicidal self-injury.Results support the notion that the behavioral inhibition system might play a role in nonsuicidal self-injury but not in suicidal self-injury.
The suicide rate (currently 14 per 100,000) has barely changed in the United States over the past 100 years. There is a need for new ways of preventing suicide. Further, research has revealed that suicidal thoughts and behaviors and the factors that drive them are dynamic, heterogeneous, and interactive. Most existing interventions for suicidal thoughts and behaviors are infrequent, not accessible when most needed, and not systematically tailored to the person using their own data (e.g., from their own smartphone). Advances in technology offer an opportunity to develop new interventions that may better match the dynamic, heterogeneous, and interactive nature of suicidal thoughts and behaviors. Just-In-Time Adaptive Interventions (JITAIs), which use smartphones and wearables, are designed to provide the right type of support at the right time by adapting to changes in internal states and external contexts, offering a promising pathway toward more effective suicide prevention. In this review, we highlight the potential of JITAIs for suicide prevention, challenges ahead (e.g., measurement, ethics), and possible solutions to these challenges.
Digital monitoring technologies (e.g., smart-phones and wearable devices) provide unprecedented opportunities to study potentially harmful behaviors such as suicide, violence, and alcohol/substance use in real-time. The use of these new technologies has the potential to significantly advance the understanding, prediction, and prevention of these behaviors. However, such technologies also introduce myriad ethical and safety concerns, such as deciding when and how to intervene if a participant's responses indicate elevated risk during the study?We used a modified Delphi process to develop a consensus among a diverse panel of experts on the ethical and safety practices for conducting digital monitoring studies with those at risk for suicide and related behaviors. Twenty-four experts including scientists, clinicians, ethicists, legal experts, and those with lived experience provided input into an iterative, multi-stage survey, and discussion process.Consensus was reached on multiple aspects of such studies, including: inclusion criteria, informed consent elements, technical and safety procedures, data review practices during the study, responding to various levels of participant risk in real-time, and data and safety monitoring.This consensus statement provides guidance for researchers, funding agencies, and institutional review boards regarding expert views on current best practices for conducting digital monitoring studies with those at risk for suicide-with relevance to the study of a range of other potentially harmful behaviors (e.g., alcohol/substance use and violence). This statement also highlights areas in which more data are needed before consensus can be reached regarding best ethical and safety practices for digital monitoring studies.
