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Archives for September 2011

Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide

Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide.
Vannoy, S., Tai-Seale, M., Duberstein, P., Eaton, L., & Cook, M. (2011). Journal of General Internal Medicine, 26(9),1005-1011.

Primary care visits are an important opportunity for detecting and responding to suicide risk among older adults. However, a research project revealed that primary care physicians who recognize suicide risk among older adult patients are often unable to effectively address this risk. The authors of an article reporting on this research suggested that physicians’ failure to develop meaningful treatment plans for older adults at risk for suicide “may reflect a lack of coherent framework for managing suicide risk, insufficient clinical skills, and availability of mental health specialty support….”

The research identified three patterns of conversations about suicide between physicians and patients. The first is the “argumentative pattern” in which physicians attempt to convince the patient that suicide is unnecessary. The authors found that this approach “results in mutual fatigue and discouragement.” A second response was the “superficial pattern” in which the physician addresses suicide risk and emotional difficulties “in a seemingly aimless manner with no clear therapeutic goal.” The third response, which the authors labeled the “insufficient pattern,” is “characterized by the physicians initially addressing the issue of suicide and comorbid mood disorder, and offering some potential courses of action, only to drop the subject precipitously with no clear sense of closure or treatment plan.”

None of these approaches contributed to developing a meaningful strategy to reduce the risk of suicide. The authors suggest that physician education and practice support may help promote the ability of primary care physicians to effectively respond to suicide risk among their older adult patients. This response could include monitoring the patient, structured follow-up, and referral to mental health specialists.

The authors caution that the small sample size used in this study limited their ability to provide definitive information on this issue and probably prevented the identification of all patterns of conversation about suicide between primary care physicians and older adult patients. The research involved the analysis of videotapes from 385 primary care office visits by patients over the age of 65. Mental health issues were discussed in 84 of these visits and suicide was discussed in six visits. These six visits represented 3 of the 35 physicians involved in the study. Mental health issues were discussed in 22 percent of primary care visits. Conversations about suicide took place in less than 2 percent of all visits.

Resource Note: The Suicide Prevention Toolkit for Rural Primary Care contains information and tools to integrate suicide prevention practices in primary care settings. The toolkit was developed by SPRC in collaboration with the Western Interstate Commission for Higher Education and can be found on the SPRC website at http://www.sprc.org/pctoolkit/index.asp
Link to Abstract

Adolescents With Suicidal Ideation: Health Care Use and Functioning


FRIDAY, Sept. 16 (HealthDay News) -- Although the U.S. Centers for Disease Control and Prevention reports that suicide is the third leading cause of death for people aged 15 to 24 years, a new study shows few suicidal teens are getting the mental health treatment they need.
The researchers found only 13 percent of teenagers with suicidal thoughts visited a mental health professional through their health care network, and only 16 percent received treatment during the year, even though they were eligible for mental health visits without a referral and with relatively low co-payments.
Even when researchers combined various types of mental health services, such as antidepressants and care received outside their health network, only 26 percent of teens contemplating suicide received help in the previous year.
"Teen suicide is a very real issue today in the United States. Until now, we've known very little about how much or how little suicidal teens use health care services. We found it particularly striking to observe such low rates of health care service use among most teens in our study," the study's lead author, Carolyn A. McCarty, of Seattle Children's Research Institute and research associate professor of pediatrics at the University of Washington School of Medicine, said in a Seattle Children's Hospital news release.
In the study, researchers analyzed the use of health care services among 198 teens ranging in age from 13 to 18 years. Half of the teenagers had had suicidal thoughts; the other half did not.
Although identifying teens with suicidal thoughts is critical, the researchers revealed mental health services were underused among all of the teens studied. Although 86 percent of the teens with suicidal thoughts had seen a health care provider, only 13 percent had seen a mental health specialist. Moreover, just 7 percent received antidepressants, the study found.
Meanwhile, only 10 percent of those without suicidal thoughts had received any mental health visits within the Group Health Cooperative system in the prior year.
Although the myth that suicidal thoughts are a normal part of growing up still persists, the findings suggest suicidal tendencies are often accompanied by trouble in school or with relationships, making mental health care even more important.
"We know that asking teens about [suicidal thoughts] does not worsen their problems," said McCarty. "It's absolutely crucial for a teen who is having thoughts of self-harm or significant depression to be able to tell a helpful, trustworthy adult."
The researchers added that primary care physicians should be screening teenagers for depression and suicidal thoughts. "Effective screening tools are available, as are effective treatments for depression," McCarty noted.
The study was published in the September issue of Academic Pediatrics.
More information
The American Academy of Child & Adolescent Psychiatry provides more information on teen suicide.
Copyright © 2011 HealthDay. All rights reserved.

http://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2011/09/16/few-suicidal-teens-get-the-help-they-need

http://www.academicpedsjnl.net/article/S1876-2859(11)00018-0/abstract

Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide

Now what should I do? Primary care physicians’ responses to older adults expressing thoughts of suicide.
Vannoy, S., Tai-Seale, M., Duberstein, P., Eaton, L., & Cook, M. (2011). Journal of General Internal Medicine, 26(9),1005-1011.

Primary care visits are an important opportunity for detecting and responding to suicide risk among older adults. However, a research project revealed that primary care physicians who recognize suicide risk among older adult patients are often unable to effectively address this risk. The authors of an article reporting on this research suggested that physicians’ failure to develop meaningful treatment plans for older adults at risk for suicide “may reflect a lack of coherent framework for managing suicide risk, insufficient clinical skills, and availability of mental health specialty support….”

The research identified three patterns of conversations about suicide between physicians and patients. The first is the “argumentative pattern” in which physicians attempt to convince the patient that suicide is unnecessary. The authors found that this approach “results in mutual fatigue and discouragement.” A second response was the “superficial pattern” in which the physician addresses suicide risk and emotional difficulties “in a seemingly aimless manner with no clear therapeutic goal.” The third response, which the authors labeled the “insufficient pattern,” is “characterized by the physicians initially addressing the issue of suicide and comorbid mood disorder, and offering some potential courses of action, only to drop the subject precipitously with no clear sense of closure or treatment plan.”

None of these approaches contributed to developing a meaningful strategy to reduce the risk of suicide. The authors suggest that physician education and practice support may help promote the ability of primary care physicians to effectively respond to suicide risk among their older adult patients. This response could include monitoring the patient, structured follow-up, and referral to mental health specialists.

The authors caution that the small sample size used in this study limited their ability to provide definitive information on this issue and probably prevented the identification of all patterns of conversation about suicide between primary care physicians and older adult patients. The research involved the analysis of videotapes from 385 primary care office visits by patients over the age of 65. Mental health issues were discussed in 84 of these visits and suicide was discussed in six visits. These six visits represented 3 of the 35 physicians involved in the study. Mental health issues were discussed in 22 percent of primary care visits. Conversations about suicide took place in less than 2 percent of all visits.

Resource Note: The Suicide Prevention Toolkit for Rural Primary Care contains information and tools to integrate suicide prevention practices in primary care settings. The toolkit was developed by SPRC in collaboration with the Western Interstate Commission for Higher Education and can be found on the SPRC website at http://www.sprc.org/pctoolkit/index.asp
Link to Abstract

Adolescents With Suicidal Ideation: Health Care Use and Functioning


FRIDAY, Sept. 16 (HealthDay News) -- Although the U.S. Centers for Disease Control and Prevention reports that suicide is the third leading cause of death for people aged 15 to 24 years, a new study shows few suicidal teens are getting the mental health treatment they need.
The researchers found only 13 percent of teenagers with suicidal thoughts visited a mental health professional through their health care network, and only 16 percent received treatment during the year, even though they were eligible for mental health visits without a referral and with relatively low co-payments.
Even when researchers combined various types of mental health services, such as antidepressants and care received outside their health network, only 26 percent of teens contemplating suicide received help in the previous year.
"Teen suicide is a very real issue today in the United States. Until now, we've known very little about how much or how little suicidal teens use health care services. We found it particularly striking to observe such low rates of health care service use among most teens in our study," the study's lead author, Carolyn A. McCarty, of Seattle Children's Research Institute and research associate professor of pediatrics at the University of Washington School of Medicine, said in a Seattle Children's Hospital news release.
In the study, researchers analyzed the use of health care services among 198 teens ranging in age from 13 to 18 years. Half of the teenagers had had suicidal thoughts; the other half did not.
Although identifying teens with suicidal thoughts is critical, the researchers revealed mental health services were underused among all of the teens studied. Although 86 percent of the teens with suicidal thoughts had seen a health care provider, only 13 percent had seen a mental health specialist. Moreover, just 7 percent received antidepressants, the study found.
Meanwhile, only 10 percent of those without suicidal thoughts had received any mental health visits within the Group Health Cooperative system in the prior year.
Although the myth that suicidal thoughts are a normal part of growing up still persists, the findings suggest suicidal tendencies are often accompanied by trouble in school or with relationships, making mental health care even more important.
"We know that asking teens about [suicidal thoughts] does not worsen their problems," said McCarty. "It's absolutely crucial for a teen who is having thoughts of self-harm or significant depression to be able to tell a helpful, trustworthy adult."
The researchers added that primary care physicians should be screening teenagers for depression and suicidal thoughts. "Effective screening tools are available, as are effective treatments for depression," McCarty noted.
The study was published in the September issue of Academic Pediatrics.
More information
The American Academy of Child & Adolescent Psychiatry provides more information on teen suicide.
Copyright © 2011 HealthDay. All rights reserved.

http://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2011/09/16/few-suicidal-teens-get-the-help-they-need

http://www.academicpedsjnl.net/article/S1876-2859(11)00018-0/abstract

Access to Firearms and Suicide Plans

Betz, M., Barber, C., & Miller, M. Suicidal behavior and firearm access: Results from the Second Injury Control and Risk Survey. Suicide and Life-Threatening Behavior, 41(4), 384-391.

A research team using data from the Second Injury Control and Risk Survey concluded that people living in homes in which firearms are present are seven times more likely to have a suicide plan involving firearms than people reporting suicide plans living in homes in which firearms are not present. In an article summarizing the results of their research, team members reported that “we found that – among those with a suicidal plan – those without a firearm in the home were significantly more likely to have a plan to overdose on medication, while those with a firearm were significantly more likely to have a plan to use a firearm.” The authors suggested that their finding reinforces “the importance of reducing a suicidal person’s access to firearms” as well as counseling family members about this issue, since suicide attempts involving firearms are far more likely to be lethal than attempts using other methods, including drug overdoses.

The study also revealed that people living in homes in which firearms are present are no more likely to experience suicidal ideation, plans, or attempts than others. Of those people who had made a suicide plan in the past 12 months, 31 percent reported a plan involving a drug overdose; 13 percent reported a plan involving a firearm; and 12 percent reported a plan involving jumping from a height. Seven percent of the respondents reported suicidal thoughts in the past year. Of those reporting suicidal thoughts, 21 percent also reported having a suicide plan. The Second Injury Control and Risk Survey is a nationally representative telephone survey conducted in 2001-2003.

Link to Abstract

Access to Firearms and Suicide Plans

Betz, M., Barber, C., & Miller, M. Suicidal behavior and firearm access: Results from the Second Injury Control and Risk Survey. Suicide and Life-Threatening Behavior, 41(4), 384-391.

A research team using data from the Second Injury Control and Risk Survey concluded that people living in homes in which firearms are present are seven times more likely to have a suicide plan involving firearms than people reporting suicide plans living in homes in which firearms are not present. In an article summarizing the results of their research, team members reported that “we found that – among those with a suicidal plan – those without a firearm in the home were significantly more likely to have a plan to overdose on medication, while those with a firearm were significantly more likely to have a plan to use a firearm.” The authors suggested that their finding reinforces “the importance of reducing a suicidal person’s access to firearms” as well as counseling family members about this issue, since suicide attempts involving firearms are far more likely to be lethal than attempts using other methods, including drug overdoses.

The study also revealed that people living in homes in which firearms are present are no more likely to experience suicidal ideation, plans, or attempts than others. Of those people who had made a suicide plan in the past 12 months, 31 percent reported a plan involving a drug overdose; 13 percent reported a plan involving a firearm; and 12 percent reported a plan involving jumping from a height. Seven percent of the respondents reported suicidal thoughts in the past year. Of those reporting suicidal thoughts, 21 percent also reported having a suicide plan. The Second Injury Control and Risk Survey is a nationally representative telephone survey conducted in 2001-2003.

Link to Abstract

WORLD SUICIDE PREVENTION DAY 2011

World Suicide Prevention Day is held on September 10th each year. The purpose of this day is to raise awareness around the globe that suicide can be prevented. Disseminating information, improving education and training, and decreasing stigmatization are important tasks in such an endeavour. The theme in 2011 is "Preventing Suicide in Multicultural Societies".
The themes of the last two years of the World Suicide Prevention Day have focussed on suicide prevention in different cultures across the world. This year's theme aims at raising awareness of the fact that all countries in the world are multicultural. Many countries harbour different minority groups, in the form of various indigenous and/or immigrant groups, refugees and/or asylum seekers. Some countries comprise many different ethnic groups due to artificial borders having been drawn by former colonial powers. This means that in all countries there are a variety of ethnic and religious groups living in the same society.
Multicultural societies require cultural sensitivity in all suicide prevention efforts. However, a common mistake is to treat culture as something objective that explains differences. When we find differences between cultural groups in a society, e.g. suicide rates and risk factors, we tend to explain these in terms of cultural differences. This can, however, conceal the real reasons for differences that may or may not have something to do with culture at all. Examples of other factors that may be important are unemployment, poverty, oppression, marginalisation, stigmatisation, or racism. Moreover, culture is not a static or measurable variable; rather culture describes the dynamics evolving in an interaction between individuals and their surroundings. So, at the same time as we need to be culturally sensitive and aware of potential cultural differences, we must not let "culture" overshadow other important factors that might be at play. Neither must we overlook similarities in our vigilance to find differences.
The WHO estimates that about one million people around the world die by suicide every year. However, many countries still lack reliable suicide statistics, and even countries with reliable statistics may lack knowledge about the magnitude of the problem in (some of) their minority populations. This knowledge might also be challenging to acquire due to stigma having a larger impact in various minority groups compared to the majority. Nevertheless, such information is needed. Some studies have shown that suicide rates among immigrants are more similar to the suicide rates of those in their original country compared to the new country in which they have settled. Other studies, however, show that this varies across country and subgroup. Therefore, we need to be careful about drawing universal conclusions.
Risk factors for suicide vary across cultural groups. Knowledge about common risk factors in a society often stems from research in majority populations. However, in a multicultural context we need to be aware that some risk factors may play different roles in the suicidal process as well as in suicide prevention for some minority groups compared to the majority population. For instance, risk factors for elderly men in the majority population may have little relevance for young immigrant girls. In addition, other factors that might have a different impact on minorities compared to the majority population are attitudes towards suicidal behaviour and suicidal people (e.g. taboo, stigma), religion and spirituality, and family dynamics (gender roles and responsibilities).
Studies have shown that stereotyping might be common in the health and social care system in dealing with minority groups. Therefore, we need to be careful to distinguish between how the rules and traditions of a cultural group define how members of that group may or should behave and how individuals from a cultural group actually do behave. We must not let stereotypes rule what we perceive or do. Some of the previous research reporting average values for immigrant groups or comparing heterogeneous groups of immigrants with the majority population in the country may contribute to such stereotyping in suicide prevention. However, it gives little meaning to compare the relatively homogeneous majority population in a small country such as, for instance, Norway, with Asian immigrants to this country since the latter group can comprise people from a vast number of very different countries, cultures and religions, as Asia stretches out from the Middle East to Siberia. In the health and social care system the individual must not be met as a representative of a cultural group, but be allowed to be themselves with their own beliefs, attitudes, understandings, thoughts, and knowledge.
Gender issues and racism in therapeutic settings are important to be aware of in multicultural societies. Use of interpreters in the health and social care system also requires special attention when a sensitive issue such as suicide is on the agenda. Often, minority populations in a community are small and interpreters are recruited from the same social circle as the client. If suicidality is particularly taboo or stigmatised in the minority group, it may be necessary to check the interpreters' attitudes towards suicidal behaviour and suicidal people because these might affect both what is being said by the client as well as what is translated and how by the interpreter.
National suicide prevention strategies have now been implemented in several countries, but not all of them reflect the fact that the country is comprised of various minority groups. The strategy/program is often aimed at the majority population and a specific cultural perspective or focus is missing. Strategies therefore may need revision with this in mind and countries still not having initiated suicide prevention efforts should integrate a cultural perspective from the start.
Even though suicide is a complex and multifactorial phenomenon with cultural differences, there are still some suicide prevention efforts that might have "universal" effect.
  • Experiences of connectedness are important in the mental health and wellbeing of all people. Thus, communities that are well integrated and cohesive may be suicide preventive.
  • Educating professionals of health and social services as well as communities in general about how to identify people at risk for suicide, encouraging those who need it to seek help, and providing them with needed and adequate help can reduce rates of suicide. These efforts require both cultural sensitivity and cultural competence.
  • Methods of suicide vary across cultural contexts, but restricting access to whatever means are commonly employed has been found to be effective in reducing the number of suicides (e.g. safe storage of firearms, pesticides and medicines; restricting access to bridges and high rise buildings commonly used as jumping sites).
  • Educating the media on how to report on suicide responsibly, and
  • Providing adequate support for people who are bereaved by suicide.
Suicide prevention in multicultural societies needs to be targeted as a multidisciplinary effort. Effective suicide prevention involves a multifaceted and intersectoral approach to address the multiple pathways to suicidal behaviour in a socio-cultural context. People who can contribute to suicide prevention include, for instance, health and social care professionals, researchers, teachers, police, journalists, religious leaders, cultural leaders, politicians and community leaders, volunteers, and relatives and friends affected by suicidal behaviour. People also tend to open up to bartenders, hairdressers, and taxi drivers, among others. In short, suicide prevention is everybody's business, and thus everyone can contribute.

WHAT YOU CAN DO TO SUPPORT WORLD SUICIDE PREVENTION DAY
WORLD SUICIDE PREVENTION DAY, September 10th, is an opportunity for all sectors of the community - the public, charitable organizations, communities, researchers, clinicians, practitioners, politicians and policy makers, volunteers, those bereaved by suicide, other interested groups and individuals - to join with the International Association for Suicide Prevention and the WHO to focus public attention on the unacceptable burden and costs of suicidal behaviours with diverse activities to promote understanding about suicide and highlight effective prevention activities.
Those activities may call attention to the global burden of suicidal behaviour, and discuss local, regional and national strategies for suicide prevention, highlighting cultural initiatives and emphasising how specific prevention initiatives are shaped to address local cultural conditions. Initiatives which actively educate and involve people are likely to be most effective in helping people learn new information about suicide and suicide prevention. Examples of activities which can support World Suicide Prevention Day include:
  • Launching new initiatives, policies and strategies on World Suicide Prevention Day
  • Holding conferences, open days, educational seminars or public lectures and panels
  • Writing articles for national, regional and community newspapers and magazines
  • Holding press conferences
  • Placing information on your website and using the IASP World Suicide Prevention Day banner, promoting suicide prevention in one's native tongue (www.iasp.info/wspd/2011_wspd_banner.php)
  • Securing interviews and speaking spots on radio and television
  • Organizing memorial services, events, candlelight ceremonies or walks to remember those who have died by suicide
  • Asking national politicians with responsibility for health, public health, mental health or suicide prevention to make relevant announcements, release policies or make supportive statements or press releases on WSPD
  • Holding depression awareness events in public places and offering screening for depression
  • Organizing cultural or spiritual events, fairs or exhibitions
  • Organizing walks to political or public places to highlight suicide prevention
  • Holding book launches, or launches for new booklets, guides or pamphlets
  • Distributing leaflets, posters and other written information
  • Organizing concerts, BBQs, breakfasts, luncheons, contests, fairs in public places
  • Writing editorials for scientific, medical, education, nursing, law and other relevant journals
  • Disseminating research findings
  • Producing press releases for new research papers
  • Holding training courses in suicide and depression awareness
  • Becoming a Facebook Fan of the IASP (www.facebook.com/IASPinfo)
  • Following the IASP on Twitter (www.twitter.com/IASPinfo), tweeting #WSPD or #suicide or #suicideprevention
  • Creating a video about suicide prevention (/www.youtube.com/IASPinfo)
  • Lighting a candle, near a window, at 8 PM in support of: World Suicide Prevention Day, suicide prevention awareness, survivors of suicide and for the memory of loved lost ones.
Light a candle on World Suicide Prevention Day - September 10th - at 8PM
http://www.iasp.info/wspd/index.php

WORLD SUICIDE PREVENTION DAY 2011

World Suicide Prevention Day is held on September 10th each year. The purpose of this day is to raise awareness around the globe that suicide can be prevented. Disseminating information, improving education and training, and decreasing stigmatization are important tasks in such an endeavour. The theme in 2011 is "Preventing Suicide in Multicultural Societies".
The themes of the last two years of the World Suicide Prevention Day have focussed on suicide prevention in different cultures across the world. This year's theme aims at raising awareness of the fact that all countries in the world are multicultural. Many countries harbour different minority groups, in the form of various indigenous and/or immigrant groups, refugees and/or asylum seekers. Some countries comprise many different ethnic groups due to artificial borders having been drawn by former colonial powers. This means that in all countries there are a variety of ethnic and religious groups living in the same society.
Multicultural societies require cultural sensitivity in all suicide prevention efforts. However, a common mistake is to treat culture as something objective that explains differences. When we find differences between cultural groups in a society, e.g. suicide rates and risk factors, we tend to explain these in terms of cultural differences. This can, however, conceal the real reasons for differences that may or may not have something to do with culture at all. Examples of other factors that may be important are unemployment, poverty, oppression, marginalisation, stigmatisation, or racism. Moreover, culture is not a static or measurable variable; rather culture describes the dynamics evolving in an interaction between individuals and their surroundings. So, at the same time as we need to be culturally sensitive and aware of potential cultural differences, we must not let "culture" overshadow other important factors that might be at play. Neither must we overlook similarities in our vigilance to find differences.
The WHO estimates that about one million people around the world die by suicide every year. However, many countries still lack reliable suicide statistics, and even countries with reliable statistics may lack knowledge about the magnitude of the problem in (some of) their minority populations. This knowledge might also be challenging to acquire due to stigma having a larger impact in various minority groups compared to the majority. Nevertheless, such information is needed. Some studies have shown that suicide rates among immigrants are more similar to the suicide rates of those in their original country compared to the new country in which they have settled. Other studies, however, show that this varies across country and subgroup. Therefore, we need to be careful about drawing universal conclusions.
Risk factors for suicide vary across cultural groups. Knowledge about common risk factors in a society often stems from research in majority populations. However, in a multicultural context we need to be aware that some risk factors may play different roles in the suicidal process as well as in suicide prevention for some minority groups compared to the majority population. For instance, risk factors for elderly men in the majority population may have little relevance for young immigrant girls. In addition, other factors that might have a different impact on minorities compared to the majority population are attitudes towards suicidal behaviour and suicidal people (e.g. taboo, stigma), religion and spirituality, and family dynamics (gender roles and responsibilities).
Studies have shown that stereotyping might be common in the health and social care system in dealing with minority groups. Therefore, we need to be careful to distinguish between how the rules and traditions of a cultural group define how members of that group may or should behave and how individuals from a cultural group actually do behave. We must not let stereotypes rule what we perceive or do. Some of the previous research reporting average values for immigrant groups or comparing heterogeneous groups of immigrants with the majority population in the country may contribute to such stereotyping in suicide prevention. However, it gives little meaning to compare the relatively homogeneous majority population in a small country such as, for instance, Norway, with Asian immigrants to this country since the latter group can comprise people from a vast number of very different countries, cultures and religions, as Asia stretches out from the Middle East to Siberia. In the health and social care system the individual must not be met as a representative of a cultural group, but be allowed to be themselves with their own beliefs, attitudes, understandings, thoughts, and knowledge.
Gender issues and racism in therapeutic settings are important to be aware of in multicultural societies. Use of interpreters in the health and social care system also requires special attention when a sensitive issue such as suicide is on the agenda. Often, minority populations in a community are small and interpreters are recruited from the same social circle as the client. If suicidality is particularly taboo or stigmatised in the minority group, it may be necessary to check the interpreters' attitudes towards suicidal behaviour and suicidal people because these might affect both what is being said by the client as well as what is translated and how by the interpreter.
National suicide prevention strategies have now been implemented in several countries, but not all of them reflect the fact that the country is comprised of various minority groups. The strategy/program is often aimed at the majority population and a specific cultural perspective or focus is missing. Strategies therefore may need revision with this in mind and countries still not having initiated suicide prevention efforts should integrate a cultural perspective from the start.
Even though suicide is a complex and multifactorial phenomenon with cultural differences, there are still some suicide prevention efforts that might have "universal" effect.
  • Experiences of connectedness are important in the mental health and wellbeing of all people. Thus, communities that are well integrated and cohesive may be suicide preventive.
  • Educating professionals of health and social services as well as communities in general about how to identify people at risk for suicide, encouraging those who need it to seek help, and providing them with needed and adequate help can reduce rates of suicide. These efforts require both cultural sensitivity and cultural competence.
  • Methods of suicide vary across cultural contexts, but restricting access to whatever means are commonly employed has been found to be effective in reducing the number of suicides (e.g. safe storage of firearms, pesticides and medicines; restricting access to bridges and high rise buildings commonly used as jumping sites).
  • Educating the media on how to report on suicide responsibly, and
  • Providing adequate support for people who are bereaved by suicide.
Suicide prevention in multicultural societies needs to be targeted as a multidisciplinary effort. Effective suicide prevention involves a multifaceted and intersectoral approach to address the multiple pathways to suicidal behaviour in a socio-cultural context. People who can contribute to suicide prevention include, for instance, health and social care professionals, researchers, teachers, police, journalists, religious leaders, cultural leaders, politicians and community leaders, volunteers, and relatives and friends affected by suicidal behaviour. People also tend to open up to bartenders, hairdressers, and taxi drivers, among others. In short, suicide prevention is everybody's business, and thus everyone can contribute.

WHAT YOU CAN DO TO SUPPORT WORLD SUICIDE PREVENTION DAY
WORLD SUICIDE PREVENTION DAY, September 10th, is an opportunity for all sectors of the community - the public, charitable organizations, communities, researchers, clinicians, practitioners, politicians and policy makers, volunteers, those bereaved by suicide, other interested groups and individuals - to join with the International Association for Suicide Prevention and the WHO to focus public attention on the unacceptable burden and costs of suicidal behaviours with diverse activities to promote understanding about suicide and highlight effective prevention activities.
Those activities may call attention to the global burden of suicidal behaviour, and discuss local, regional and national strategies for suicide prevention, highlighting cultural initiatives and emphasising how specific prevention initiatives are shaped to address local cultural conditions. Initiatives which actively educate and involve people are likely to be most effective in helping people learn new information about suicide and suicide prevention. Examples of activities which can support World Suicide Prevention Day include:
  • Launching new initiatives, policies and strategies on World Suicide Prevention Day
  • Holding conferences, open days, educational seminars or public lectures and panels
  • Writing articles for national, regional and community newspapers and magazines
  • Holding press conferences
  • Placing information on your website and using the IASP World Suicide Prevention Day banner, promoting suicide prevention in one's native tongue (www.iasp.info/wspd/2011_wspd_banner.php)
  • Securing interviews and speaking spots on radio and television
  • Organizing memorial services, events, candlelight ceremonies or walks to remember those who have died by suicide
  • Asking national politicians with responsibility for health, public health, mental health or suicide prevention to make relevant announcements, release policies or make supportive statements or press releases on WSPD
  • Holding depression awareness events in public places and offering screening for depression
  • Organizing cultural or spiritual events, fairs or exhibitions
  • Organizing walks to political or public places to highlight suicide prevention
  • Holding book launches, or launches for new booklets, guides or pamphlets
  • Distributing leaflets, posters and other written information
  • Organizing concerts, BBQs, breakfasts, luncheons, contests, fairs in public places
  • Writing editorials for scientific, medical, education, nursing, law and other relevant journals
  • Disseminating research findings
  • Producing press releases for new research papers
  • Holding training courses in suicide and depression awareness
  • Becoming a Facebook Fan of the IASP (www.facebook.com/IASPinfo)
  • Following the IASP on Twitter (www.twitter.com/IASPinfo), tweeting #WSPD or #suicide or #suicideprevention
  • Creating a video about suicide prevention (/www.youtube.com/IASPinfo)
  • Lighting a candle, near a window, at 8 PM in support of: World Suicide Prevention Day, suicide prevention awareness, survivors of suicide and for the memory of loved lost ones.
Light a candle on World Suicide Prevention Day - September 10th - at 8PM
http://www.iasp.info/wspd/index.php