Research

Suicide Trends in At-Risk Territories Study in the Western Pacific Region: The START Study

Commonwealth Department of Health and Ageing and World Health Organization.

Evidence from the World Health Organization shows that in 2002, the rate of suicide in the Western Pacific Region was 19/100,000, which is more than 30% higher than the average world rate for the same year (14/100,000) (World Health Organization, 2004). The countries of the Western Pacific Region have significant cultural differences and are at varying stages of social and economic development.

The Suicide Trends in At-Risk Territories study was inspired by AISRAP and initiated by the Western Pacific Regional Office of World Health Organization to develop a greater understanding of the trends of both fatal and non-fatal suicidal behaviour, and to provide an appropriate cross-cultural treatment intervention.

As a Collaborating Centre for World Health Organization, the Australian Institute for Suicide Research and Prevention provides technical support for the project, which has also been endorsed by the International Association for Suicide Prevention. The first stage of the study commenced with a four-day training workshop in March 2006 with twenty nations in attendance. A training and research protocol manual has been developed to assist these countries in conducting the study. This study will provide significant insights into the cultural factors involved in suicidal behaviours not only in the region but also in Australia.

General Management: Dr Wang Xiangdong (Western Pacific Region Office of the World Health Organization)
Project Leader: Prof. Diego De Leo
Project Officer: Ms Allison Millner, Dr Kairi Kõlves

Beyond psychopathology: Pathways to suicide in mentally well young adult males

Australian Research Council Discovery Project (2008-2011). Partners include the Queensland Office of the State Coroner and Queensland Health.

The goal of this study is to investigate suicide risk factors among adult males in Australia (25-44 age) with no psychiatric diagnosis. The psychological autopsy (interviews with the next-of-kin of the suicide victims) will be used together with analysis of coronial, police and medical files and compared with a control group of sudden death victims. This study aims to investigate whether there are any differences in the contributing risk factors. It will review their relative influences, in order to develop and implement targeted suicided prevention initiatives beyond those based on a medical/psychiatric treatment paradigm.

Project Leader: Prof. Diego De Leo
Project Coordinator: Dr Helen Klieve
Project Officers: Ms Jerneja Sveticic, Ms Davina Donovan

Suicide in separated males - An investigation into suicidal behaviours in males experiencing marital and de facto separation

Australian Research Council Discovery Project (2005-2007). Partners include Mensline Australia, Lifeline (Brisbane and Caboolture), Lifeline WA, Men’s Information and Support Association, Kinections, Caxton Legal Centre, Centacare Sydney, Relationships Australia, Support Groups for Men and Women

This three-year study investigates the impact of marital and de facto separation on men’s psychological well-being. Little is known about what causes the most distress and at what point during the separation process this distress occurs. This is a multi-stage investigation of suicidality by males who are experiencing relationship breakdown.

Phase one and two examine existing AISRAP databases on fatal and non-fatal suicidal behaviour. Males who were separated at the time of death/attempt (from both the World Health Organisation SUicide PREvention Multisite Intervention Study Community Survey and the QSR) are compared to males with intact relationships. Similarly, females who were separated are compared with females from intact relationships at the time of death/attempt. Critical factors that distinguish these groups are examined.

Phase three of the investigation is the collection of data from persons in the process of separation. The role of relationship breakdown is investigated in the development of suicidal thoughts, gestures, and behaviours in males and aims to identify risk and protective factors, interactions of factors and timing of suicidal thoughts. Findings of the study will inform best practice for service providers and government.

Project Leader: Prof. Diego De Leo
Project Coordinator: Ms Jacinta Hawgood
Project Officer: Ms Naoko Ide, Ms Kirsty Andersen, Dr Kairi Kõlves

Psychological autopsy study of the last contact with a health professional before suicide

Australian Research Council Linkage Project (2005-2008). Partners include Queensland Health, Queensland State Coroner, Lifeline Caboolture, Black Dog Institute, NSW Centre for Mental Health, Primary Health Institute, Commonwealth Department of Veterans’ Affairs, South East Health

This Australian Research Council-Linkage Project is a collaborative project with the Australian Institute for Suicide Research and Prevention, Prince of Wales Hospital in Sydney, and Central Sydney Area Health Services. The study examines the last clinical contact suicide victims had with health professionals to determine whether this contact offered an opportunity for suicide prevention. This controlled study, using the Psychological Autopsy method, gathers detailed information on suicide victims over the age of 35, from two Australian sites (i.e. NSW and Qld). This information is compared to a matched control group of sudden death victims.

General Practitioners and other health professionals, as well as the deceased’s next-of-kin, are interviewed to determine the context surrounding the death, and the abilities of health professionals to identify warning signs and to intervene prior to suicide. Given Australia’s aging population, the outcomes will be significant in educating heath professionals to identify warning signs, and to prevent premature death in the elderly.

Project Leader: Prof. Diego De Leo
Project Investigators: Prof. John Snowdon, Associate Prof. Brian Draper
Project Coordinator: Mr Keith Harris
Project Officer: Ms Meadean Brown, Ms Davina Donovan, Dr Eric Djee Chan

Post discharge care in high-risk psychiatric patients

Commonwealth Department of Health and Ageing (National Suicide Prevention Strategy) (2002-2007). Partners include the Gold Coast Integrated Mental Health Service and Lifeline Gold Coast.

This study aims to determine the effectiveness of an intensive case management model in reducing suicide risk among patients discharged from psychiatric care. Funded by the National Suicide Prevention Strategy (2002-2007) this project involves 120 males from the Gold Coast Hospital who were hospitalised for mental health problems and severe suicidality. Patients were randomly assigned to one of two conditions: Intensive Case Management or Treatment As Usual.

Intensive Case Management patients received weekly case management sessions from an experienced case manager (Queensland Health) plus outreach telephone calls (Lifeline) twice weekly for one year. The Treatment As Usual group received the care usually provided to people discharged from a psychiatric ward including referrals to general practitioners, case managers, other community services etc. Patients were assessed at six- and twelve-month follow-ups for evaluation of their current mental health status and suicidality, help-seeking behaviours, satisfaction of the health care system, and social functioning. The results form this study will be published in mid to late 2008.

Project Leader: Prof. Diego De Leo
Project Coordinator: Ms Jacinta Hawgood
Project Officers: Ms Kirsty Andersen, Ms Naoko Ide, Dr Helen Klieve
Clinical Interviewers: Mr Govind Krishnamoorthy, Ms Angie Wakelin and Mr Pejman Hoviatdo

Queensland Suicide Register

Queensland Health (since 1995). Partners include the Queensland State Coroner Office and Coronial Support Unit, Queensland Police Service.

The Queensland Suicide Register funded by the Queensland Health, is the only comprehensive database of its type in Australia and in the Asia Pacific region. The Register is central to AISRAP’s research: it is a database of all suicides in Queensland from 1990 to the present. The database includes information from three sources: post-mortem forms, toxicology reports, and Form 1 (including psychological autopsy reports). Psychological autopsy reports are completed by Queensland Police officers in the investigation of possible suicides, following interviews with those close to the deceased, and include information pertaining to psychosocial, behavioural, and demographic data. Form 1 is continually utilised by both AISRAP and the office of the State Coroner, with last version adopted in December 2006.

AISRAP employs a three-tiered classification of suicides scale: Beyond Reasonable Doubt, Probable, and Possible. The Queensland Suicide Register is the major source of data used in the preparation of the triennial suicide report, the most recent being Suicide in Queensland 2002 to 2004 released in 2006.

Some examples of previously conducted research based on the Queensland Suicide Register data include

• Suicide in the Building Industry
• Suicide from the Story Bridge
• Suicide and schizophrenia
• Suicide in the Queensland Rail
• Suicides and motor vehicle accidents
• Firearm Suicides
• Suicide in Opiate users
• Fear of losing sight
• Relationship issues and suicides
• Trends in suicide and suicide methods

Project Leader: Prof. Diego De Leo
Register Manager: Dr Helen Klieve
Register Officer: Ms Allison Milner, Ms Jerneja Sveticic

Queensland Suicide Register Quality Control Study

2005 onwards. Partners include Qld State Coroner and Coronial Support Unit Qld Police Service.

In 2005, a Quality Control Study of Queensland Suicide Register data was initiated. A proportion of suicide survivors have agreed to be re-interviewed up to 10 months after the loss of their loved one. The psychological autopsy/Form 1 interview schedule originally performed by the police officers investigating the death is re-administered. This study aims to check the reliability of the information collected immediately following the death, in comparison to months later. In addition, the use of trained clinical interviewers as opposed to police officers is being evaluated. Sub-samples of cases are also administered the Structured Clinical Interview for the Diagnostic and Satistical Manual, performed by trained professionals.

Project Coordinator: Dr Helen Klieve

Learning from the experts: Building bridges to implement successful life promotion and suicide prevention expertise across Aboriginal communities.

Centre for Rural Remote Mental Health Queensland National Suicide Prevention Strategy Project. Commonwealth of Australia, Department of Health and Aging.

AISRAP is undertaking the evaluation of the National Suicide Prevention Strategy project “Learning from the Experts”.

This project seeks to establish effective and sustainable community-based approaches to building resilience, reducing risk exposure and reducing self-harming behaviours in Indigenous communities.

Three areas have been identified for development:

• Addressing limitations in knowledge and understanding
• Developing sustainable intervention models that have been implemented and followed over time
• Developing a reliable evaluation process

The project focuses on regional interventions (including local-level activities) that will build the resilience of indigenous communities. These include increased knowledge transfer and dialogue of these issues within the specified communities. The development of an effective evaluation process is important not only for this project but also as a model for the development of evaluation processes in the area of suicide prevention strategies in indigenous communities.

Project Leader: Prof. Diego De Leo
Project Coordinator: Dr Helen Klieve
Project Officer: Ms Kathy McKay, Ms Jerneja Sveticic, Ms Allison Milner

Indigenous suicide in Queensland

Queensland Health

This research will provide increased understanding and awareness of the cultural aspects of Indigenous suicide as well as the incidence of suicide in Indigenous communities. The study will include the following:

• A literature review of the international and Australian literature on indigenous suicide epidemiology and characteristics elsewhere in the world and in other states of Australia; the impact of historical, social and cultural issues and the impact of suicide contagion
• Analysis of the extensive data collected through the Queensland Suicide Register 1994-2004 for the key characteristics relating to indigenous suicide
• Enhanced understanding of the differences between Indigenous and non-indigenous suicide, to enable policy interventions for community and individuals at risk

Project Leader: Prof. Diego De Leo
Project Coordinator: Dr Helen Klieve
Project Officer: Ms Kathy McKay, Ms Jerneja Sveticic