A sample of completed projects from the Australian Institute for Suicide Research and Prevention (AISRAP)
Preventing suicide: A Psychological autopsy study of the last contact with a health professional before suicide
Australian Research Council Linkage Project LP0562078 (2005-2009).
Partners include Queensland Health, Queensland office of the State Coroner, Lifeline Caboolture, Black Dog Institute, NSW Centre for Mental Health, Primary Health Institute, Common wealth Department of Veterans Affairs, South East HealthMen and Women.
In Australia 48% of all suicides in 2000 were by 35-64 year olds; an additonal 13% were by 65% and over. This study examined the last clinical contact older suicide victims had with health professionals in order to determine whether this contact offers an opportunity for intervention. For the first time in Australia, GP's, health professionals, and the deceased's next-of-kin will be interviewed to determine the context surrounding deceased's death, and the abilities of health professionals to identify warning signs and to intervene prior to suicide. Given our ageing population, the outcomes will be significant in educating all health professionals to identify suicidal signs and to prevent premature death in the elderly.
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.
Queensland Suicide Register Quality Control Study
Partners include Qld State Coroner and Coronial Support Unit Qld Police Service.
This study aims to check the accuracy and completeness of the information collected in the Queensland Suicide Register. Data gathered in the Form 1 by police officers immediately following the death by suicide (via an interview with the deceased?s next-of-kin) is compared to the results of an in-depth interview with suicide survivors that have agreed to be contacted again between 6 and 24 months after the death of their loved one. A trained clinical interviewer performs an interview enquiring about the deceased?s recent life events, history of suicidal behaviour, medical history, and psychiatric illness as assessed via the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID).
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.
Building Bridges: Learning from Experts - Evaluation Report.
Centre for Rural and Remote Mental Health Queensland
The Building Bridges Project engaged an approach not previously undertaken in the implementation and dissemination of successful Indigenous suicide prevention activities. Building Bridges built on and extended the local responses to self-harming and suicidal behaviours that had been developed and found to be effective in Yarrabah during the 1990s. It extracted the critical elements from this community-driven process and expanded the activities undertaken. Further, it enabled the horizontal knowledge transfer of risk-reducing and resilience-enhancing strategies and activities through partner organisations to two regional communities in Cape York, one rural setting in Southwest Queensland and a correctional facility in which the majority of prisoners are Indigenous. This project sought to strengthen communities? capacity to recognise, understand and implement suicide prevention, intervention and postvention activities.
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 in Queensland. The study will include the following:
- A literature review of the international and Australian literature on epidemiology and characteristics of Indigenous suicide, with focus on historical, social and cultural issues and the impact of suicide contagion;
- Analysis of the extensive data on all suicide cases collected through the Queensland Suicide Register from 1994 to 2006, comparing the trends of suicide mortality and key characteristics of Indigenous and non-Indigenous suicides;
- Enhanced understanding of the particularities of suicidal behaviours in Indigenous populations to enable policy interventions for communities and individuals at risk.
Redevelopment of the Living is For Everyone (LiFE) Framework: Research and Evidence (2007)
Commonwealth of Australia, Department of Health and Ageing, Corporate Diagnostics Proprietary Limited
Following consultations with key suicide prevention stakeholders, in early 2006 the Commonwealth Department of Health and Ageing recommended a review of the Living is For Everyone (LiFE) Framework. The Framework provides the overall structure and conceptual guidance for the National Suicide Prevention Strategy in Australia. In order to clarify its purpose and ensure that the framework is reflective of a diverse Australia, and due to the need for greater integration and practical application of information presented in the framework documents and publications, the Redevelopment of the LIFE Framework Project commenced. A new framework Life is for Living has been developed and will be implemented in 2008. AISRAP was in charge of providing the scientific background, systematically analysing the available evidence.
An investigation on suicide in Queensland rail lines - Queensland Rail (2006 - 2007)
Queensland Rail
The study reviewed the epidemiology of non-fatal and fatal suicidal behaviour on the Queensland Rail network, and the socio-demographic and clinical characteristics of individuals who engaged in these behaviours, comparing the emerging evidence against the results of international studies. In addition, by reviewing international literature and the available evidence of the effectiveness of existing rail suicide prevention initiatives, the study explored the potential for suicide prevention of suicide on the Queensland Rail network.
Online Suicide Prevention Skills Training (e-SPST): Design, delivery and evaluation of suicide prevention and mental health training online
Commonwealth Department of Health and Ageing (National Suicide Prevention Strategy) (2004-2006). Partners include Royal Flying Doctors Service, Queensland Ambulance Service, the Park Centre for Mental Health Treatment, Research and Evaluation, Queensland AIDS Council, Queensland Transcultural Mental Health Centre
The objective of this project was to evaluate the effectiveness of the e-SPST on worker competency, especially on service delivery outcomes. Specific aims were: a) to evaluate worker competency in suicide prevention, intervention and postvention, and b) to determine the impact of training on worker knowledge and skills gained and retained at 6 months follow-up. This online training program is the only web-based flexible learning program in suicide prevention and mental health in Australia. It is a modularised course offering contemporary education in the field of suicide prevention, intervention and postvention, with interactive activities and learning scenarios provided via Blackboard (Version 6, hosted by Griffith University servers). The target audience is: workers in the field of mental health, general and allied health, emergency services, education, youth work, ministry and clergy, and community welfare.
Suicide in the Building Construction Industry (2003-2006)
Queensland Commercial Building Industry Suicide Prevention Committee
A Royal Commission into the Building and Construction Industry (BCI)reported that almost half of all death claims lodged within the industry were in relation to a suicide. Concerned representatives from within the industry approached AISRAP to conduct a multi-phase project on this problem. The first phase of the study involved determining the incidence of suicide within the BCI. By accessing industry databases, and cross-referencing with the Queensland Suicide Register, the researchers were able to identify 67 suicides across the period 1995-2001, equivalent to an average of 9.6 suicides in the industry each year. Suicide rates for construction workers peaked in 1998 at 54.9 per 100,000 persons. Young workers (15-24 year olds) were at significant risk of suicide. The second phase of this project involved accessing psychological autopsy data and conducting focus groups with industry representatives to try to understand cases of this phenomenon. Recommendations were made to the Steering Committee for future industry-specific prevention strategies.
Child and Adolescent Self-Harm in Europe (CASE) Study (2002-2004)
Commonwealth of Australia, Department of Health and Ageing and Queensland Health Partners include Gold Coast Public Health, Gold Coast Hospital
AISRAP participated in this international project, with the Gold Coast being the only non-European site included. This school-based study aimed to produce methodologically sound comparative data on deliberate self-harm (DSH) across different countries, by developing and utilising a standard definition of DSH. On the Gold Coast, 3,757 high school students (aged 15-16 years) completed the self-report Lifestyle and Coping Questionnaire, which investigated sociodemography, lifestyle choices, recent stressors, suicidal thoughts and behaviours, personality items, psychological symptoms, and coping techniques. In total, 233 students (6.2%) met the criteria for DSH in the 12 months preceding administration of survey. DSH was more prevalent in females than males (11.1% vs. 1.6%). The main methods of DSH were self-cutting (59.2%) and overdosing with medications (29.6%). Factors associated with DSH included exposure to non-fatal suicidal behaviours in friends and family, self-blame as a coping style, and self-prescription of medication. The majority of self-harmers did not seek professional help before or after their DSH act, with friends the most likely to be aware of these behaviours.
World Health Organization SUIcide PREvention Multisite Intervention Study: WHO SUPRE-MISS (2001-2004)
National Health and Medical Research Council, Queensland Health and Commonwealth of Australia, Department of Health and Ageing Partners include Queensland Health
This project was designed to assist in the reduction of suicidal ideation and behaviour represented, and is part of a large international collaboration. Countries involved included China, Vietnam, Estonia, Brazil, India, Sri Lanka, Iran, and South Africa. There are two main aspects in the WHO SUPRE-MISS project is a community survey and an intervention study. The community survey was piloted in Australia (Gold Coast and Brisbane) with more than 13,000 people taking part (one of the largest studies of this kind in Australia). Randomized telephone interviews through Computer Assisted Telephone Interviewing (Cati)facilities were conducted to determine the lifetime prevalence of suicidal ideation and attempts and corresponding socio demographic and cultural characteristics of prticipants. A follow-up postal survey was sent to consenting people who indicated a history of suicide ideation/attempt. The survey, completed by 1,311 people, investigated psychiatric and psychological factors, suicidal transmission, help seeking and service utilisation factors. Some of the main findings included: knowledge of someone else's suicide behaviour increased the risk of similar acts; problem with partner was the commonest triggering event preceding suicidal behaviours; less than 30% of participants were treated in the hospital as a consequences of suicidal behaviour; treatment received at hospitals was rated less positively than treatment received from general practitioners; and, the ratio of fatal and non-fatal suicidal behaviours in the study sites was 1 to 23. International comparisons of the prevalence of suicidal thoughts, plans and attempts between culturally diverse sites has been conducted and published, as well as the results of the intervention study.
ACROSSnet (Australians Creating Rural Online Support Systems Network) - The development and evaluation of an online support system for mental health workers in rural, remote, and regional areas (2002-2005)
Australian Research Council Linkage Project. Partners include Queensland University of Technology, University of Queensland, Queensland Health, Lifeline, Kids Helpline, Queensland Department of Families.
The ACROSSnet project was a 3-year Australian Research Council-Linkage project between the Australian Institute for Suicide Research and Prevention, the Service Leadership and Innovation Research Program at Queensland University of Technology, and the Centre for Online Health at the University of Queensland. Support was provided by the Queensland Government Department of Health representing the Queensland Suicide Prevention Strategy Committee, and by two help-lines and online counselling services (Kids Helpline and Lifeline). The project was aimed at assisting suicide prevention workers, mental health professionals and other members of rural and remote communities to access information, education and support on suicide and its prevention.
Suicides from the Story Bridge - Characteristics and potential for prevention (2004)
Brisbane City Council
In Queensland, the Story Bridge in Brisbane has notoriety as a suicide 'hot-spot'. The Story Bridge is a 281-metre cantilever truss bridge that crosses the Brisbane River from Kangaroo Point to Brisbane City. In 2004, the Brisbane City Council funded a review of suicide deaths from the Story Bridge between 1990 and 2001. During that period, out of the Of 81 suicides from bridges in Queensland, 39 were from the Story Bridge (48.1%), while 32 occurred at the Gateway Bridge (39.5%), four from other bridges in Brisbane (4.9%), and six from bridges in regional Queensland (7.4%). Although there were seven more suicides from the Story Bridge than the Gateway Bridge, this difference was not statistically significant. However, from 1997 to 2001 there were significantly more suicides from the Story Bridge than the Gateway Bridge. Since the erection of barriers on the Gateway Bridge in 1993 there has been a significant reduction in the number of suicides. The report to the Brisbane City Council provided recommendations for preventing future suicides, including physical barriers, video surveillance, telephone helplines on the bridge, and closing of the bridge to pedestrian access at night.
International suicide rates and prevention strategies (2004)
Partner: Commonwealth Department of Health and Ageing
The National Advisory Council on Suicide Prevention commissioned a report to AISRAP in order to investigate international suicide rates and their relationship with Australia's suicide situation. The report reviewed the suicide rates from 32 countries with reliable suicide reporting procedures to the WHO and from eight regions (Old World [Anglo], New World [Anglo], Scandinavia, Western Europe, Eastern Europe, Southern Europe, Latin America, Asia). From 1960 to 2000, there was a 7% increase in suicide rates for males, and a 27% decrease for females. Additionally, a review of the impact of national suicide prevention strategies was conducted in countries where these have been established. Suicide rates in countries with and without national strategies have experienced periods of decline in recent times, suggesting that strategies have limited impact thus far. The final report of this study, printed by the Commonwealth Department of Health and Ageing, was subsequently published as a book by Hogrefe and Huber.