OBJECTIVE:This study described historical changes in the proportional age distribution of recorded suicide deaths and variation by sex and broad region, without interpreting death shares as age-specific risk. METHOD:A longitudinal ecological analysis used 9,396 country-year-sex records from 118 countries during 1950-2020. Suicide deaths were grouped as ages 0-14, 15-24, 25-44, 45-64, and 65 years and older. A grouped multinomial model analyzed the five-part composition, and 1,000 stratified country-cluster bootstrap samples preserved complete national time series for 95% confidence intervals (CIs). RESULTS:The standardized share at ages 15-24 decreased from 16.1% in 1950 to 11.3% in 2020 (-4.8 percentage points, 95% CI [-14.4, -2.3]). Point estimates increased at ages 25-44 (+3.5 points) and 65 years and older (+1.4 points), but both CIs included no change. Compositions differed by sex and region, with substantial uncertainty where few countries reported. CONCLUSIONS:The data support a decline in the proportional share of recorded suicide deaths at ages 15-24, not a demonstrated decline in youth suicide risk. Other apparent redistributions were less certain after country-clustered compositional analysis and may reflect demographic structure, reporting coverage, or changes in other age groups.
OBJECTIVE:This study investigated how adolescents' experience of suicidal ideation over time relates to academic and career development, both of which are regarded as critical areas of development. Specifically, we examined how latent trajectories of suicidal ideation are associated with academic engagement, academic helplessness, and career adaptability. METHOD:Latent class growth analysis (LCGA) and regression analyses were conducted using six waves of data from the middle school panel of the Korean Children and Youth Panel Survey 2018 (2018-2023; N = 1,936). RESULTS:Four distinct latent trajectories of suicidal ideation were identified, characterized by significant group differences in academic and career-related variables: elevated-plummet (7.0%), moderate-surge (8.7%), moderate-rise (38.6%), and persistently low (45.7%). Results showed that both current and past levels of suicidal ideation were associated with academic engagement and helplessness, whereas career adaptability was more strongly linked to current experiences of suicidal ideation. CONCLUSIONS:These findings advance existing scholarship by shifting attention from antecedents of suicidal ideation to developmental experiences. Moreover, the findings highlight high-priority areas for early intervention among adolescents experiencing suicidal ideation and provide empirical evidence to inform the design of programs aimed at strengthening academic and career competencies.
OBJECTIVE:This study aimed to examine the impact of suicide interventions on secondary outcomes, such as non-suicidal self-injury (NSSI), potentially suicide-related ED visits and hospitalizations, behavioral health interactions, and quality of life (QOL). METHOD:Data were analyzed from 1,376 adults, who screened positive for suicide risk as part of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study, a quasi-experimental, eight-center study, conducted from 2010-2013. Participants were enrolled across three phases: Treatment as Usual (TAU), Universal Screening (US), and Universal Screening + Intervention (Intervention). Outcomes were assessed during the 12-month follow-up period. RESULTS:Participants in the Intervention phase reported fewer potentially suicide-related hospitalizations during the 12-months follow-up compared with those in the TAU or US phases. Intervention participants also reported more behavioral health interactions via phone at follow-up than those in TAU. Additional factors associated with secondary outcomes are discussed. CONCLUSION:Suicide interventions implemented in the ED may have benefits beyond reducing suicide behavior, including reduction in potentially suicide-related hospitalizations and increased engagement with behavioral health services by phone. These findings highlight the potential for ED-based suicide prevention strategies to influence broader health outcomes.
OBJECTIVE:Sexual and gender minority (SGM) people experience higher rates of suicidal ideation than cisgender heterosexual (cis/het) individuals. The Integrated Motivational-Volitional (IMV) model proposes key psychological mechanisms (i.e., defeat and entrapment) that contribute to suicide ideation. Examining IMV processes between SGM and cis/het adults can uncover the universality of defeat-entrapment pathways in suicide risk and inform for whom interventions targeting these mechanisms may be most effective. METHOD:The current study examined SGM status as a moderator between defeat/entrapment, and suicidal thoughts across two adult samples: a college student sample in the United States (Sample 1; n = 865) and an adult community sample in the United Kingdom (Sample 2; n = 734). RESULTS:SGM participants reported higher rates of lifetime suicidal ideation across both samples, and higher levels of defeat and entrapment as compared to cis/het in Sample 1. Defeat and entrapment were significantly associated with suicide ideation in both samples. In Sample 1, SGM status moderated the association between entrapment and suicide ideation, but not between defeat and suicide ideation. The relationship between entrapment and suicide ideation was stronger for SGM people. In Sample 2, no moderation effects of SGM status were found. CONCLUSIONS:Findings highlight that across contexts, defeat and entrapment are key correlates of suicidal distress. For SGM adults, minority stressors and related mechanisms may increase suicide risk alongside defeat and entrapment. Future research should explore both shared and identity‑specific pathways to suicide risk as well as develop contextually sensitive suicide prevention approaches that integrate both IMV mechanisms and minority stress frameworks.
INTRODUCTION:Clarifying risk factors for suicidal behavior in European youth is crucial for guiding assessment, prevention, and policy. This study provides a systematic review and synthesis of risk factors associated with suicidal ideation, attempts, and mortality across Europe. METHODS:Following PRISMA guidelines and a PROSPERO-registered protocol, we reviewed studies published between 1976 and 2024 involving European general populations aged 15-35. A total of 10,832 unique records were screened across PubMed, Web of Science, and Scopus, resulting in the inclusion and quality appraisal of 194 studies. RESULTS:Lifetime prevalence estimates ranged from 14-23% for ideation and 6-9% for attempts. The data confirmed a robust gender paradox: higher rates of ideation and attempts in women, but higher mortality in men. Risk factors spanned ten thematic domains: sociodemographic and identity, educational, family, victimization and childhood trauma, social connectedness, individual traits and coping, sleep and physical health, substance use and addictive behaviors, psychopathology and mental health, and prior suicidal behaviors. Research coverage was markedly uneven, with Northern & Western Europe accounting for most included studies. CONCLUSION:These findings highlight suicidal behavior in European youth as a critical, multifactorial public health issue. Compared to other world regions, European research distinctively documents sexual minority status and sleep/physical health correlates as consistent risk domains. Coordinated public policies should integrate suicide prevention into youth health agendas, prioritizing LGBTQ+ inclusive programs, post-self-harm monitoring, and digital risk assessment, alongside gender-sensitive approaches and targeted support for vulnerable groups.
OBJECTIVE:Attention has been given on the terminology used for suicidal behaviors, however, there is paucity of research on the terminology used for those with thoughts of self-harm and this is imposing a risk of overlooking sub-groups within the suicidality spectrum. This review therefore aimed to map the existing evidence on the conceptualization and measurement of self-harm ideation. METHOD:A two-stage search strategy was employed. In stage one, MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science Core Collection were searched were searched in June 2020 for records published from database inception onwards, using database-specific index terms and title/abstract keywords related to self-harm ideation/thoughts. In stage two (2020-2025), a targeted title only search was conducted to identify studies explicitly foregrounding self-harm ideation. Data were synthesized using descriptive narrative methods. RESULTS:The majority of studies (68%) used standardized instruments, most commonly items embedded within broader mental health scales, particularly item 9 of the Patient Health Questionnaire-9 (PHQ-9) and item 10 of the Edinburgh Postnatal Depression Scale (EPDS) in female perinatal samples. A smaller number of studies used the Self-Injurious Thoughts and Behaviors Interview (SITBI) items assessing non-suicidal self-injury thoughts. Publication output increased substantially after 2013 and was largely concentrated in high-income Western countries. Across all years examined, explicit use of the terms self-harm ideation or thoughts in titles remained consistently low (10%). CONCLUSIONS:Future research should prioritize participatory approaches involving clinicians and individuals with lived experience to refine the terminology surrounding self-harm ideation and support more accurate identification and targeted prevention strategies.
OBJECTIVE:Low perceived control over suicidal urges has been associated with greater suicide risk. Within Self-Determination Theory, causality orientations are stable motivational drivers shaping beliefs about control over external events. Orientations are three separate but related dimensions varying in levels of perceived agency (autonomous, control, impersonal). This study is believed to be the first to explore relationships between causality orientations and suicidal thoughts and behaviors (STBs). METHODS:Participants were users of an Australian suicide safety planning smartphone app (N = 589) with a lifetime history of STBs. Measures included causality orientation, past-month suicidal ideation, future suicide intent, and lifetime suicidal behaviors. Correlations, logistic, and multiple regressions explored cross-sectional associations between causality orientations and STBs. RESULTS:Low agency (impersonal orientation) was associated with higher past-month suicidal ideation and future suicide intent. Autonomous orientation was associated with greater odds of a lifetime suicide plan. Participants high on both impersonal and autonomous orientations reported higher past-month suicidal ideation and greater likelihood of a past-month suicide attempt. All effect sizes were small. CONCLUSIONS:Causality orientations explain limited variance in lifetime and past-month STBs. Motivational beliefs reflecting futility (impersonal) or conflicted agency (impersonal + autonomous) may contribute modestly to suicidal distress alongside other risk factors. Future studies could examine real-time motivational drivers of STBs.
OBJECTIVE:People with chronic illnesses are at elevated risk of suicide. Prior research has focused on risk with specific diagnoses and/or comparisons with living controls; the profiles of medically ill people who die by suicide remain largely unknown. This study aims to identify characteristics and subgroups among suicide decedents with medical illnesses. METHODS:We conducted a retrospective chart review of 5288 suicide deaths in Toronto, Canada (1998-2020) using coroner records. Bivariate and logistic regression compared decedents with and without reported medical illness across demographics, stressors, psychiatric history, and suicide-related characteristics. Latent class analysis (LCA) identified subgroups based on patterns of medical illness and sociodemographic characteristics. Post-hoc comparisons assessed additional differences across classes. RESULTS:Among suicide decedents, 33.6% had a reported medical illness. Compared to other suicide decedents, they were older, more likely to die at home, experience depression, and use self-poisoning. Latent class analysis identified four distinct profiles defined by medical and sociodemographic characteristics: (1) older men with cardiovascular disease and/or diabetes; (2) middle-aged individuals with pain, neurological, and/or musculoskeletal conditions and a balanced sex distribution; (3) younger-to-middle-aged men with mixed medical conditions, including HIV/AIDS and respiratory illness; and (4) older men with reported malignancy. Exploratory post-hoc comparisons suggested additional differences across psychiatric, psychosocial, and suicide-related characteristics, including depression, substance misuse/use disorder, and suicide methods. CONCLUSIONS:Our results indicate that the characteristics of suicide among medically ill populations are heterogeneous. Tailored, integrated prevention strategies that address both medical illness and psychosocial context are important elements for addressing suicide in this group.
OBJECTIVE:Most self-report measures of suicidal ideation (SI) index thoughts or behaviors but broadly fail to contextualize the degree to which SI is perceived to impair quality of life. Theories of suicide propose that psychological inflexibility (i.e., metacognitive distress) about SI may compound suicidal cognitions and impact suicide risk. This study tested whether suicidal cognitions and psychological inflexibility about SI interact to amplify SI severity. METHODS:Self-report measures of suicidal cognitions, psychological inflexibility, and SI severity were collected from U.S. military veterans (N = 87) with current SI at a health care system in the Southeast United States. The sample primarily identified as male (70%) and White/Caucasian (45.6%). A moderation model tested main and interactive effects of suicidal cognitions and psychological inflexibility about SI on SI severity. RESULTS:There was a significant interaction between suicidal cognitions and psychological inflexibility about SI, such that the statistically significant relationship between suicidal cognitions and SI severity increased at each level (-1 SD, mean, and +1 SD) of psychological inflexibility about SI. CONCLUSIONS:Psychological inflexibility about SI may amplify SI severity, which has theoretical implications for ideation-to-action frameworks of suicide. In addition to treating underlying suicidal cognitions, patients may benefit from addressing concerns about the meaning and impact of SI itself.
OBJECTIVE:Suicide attempts among adolescents in acute mental health crisis are frequent but difficult to predict. Our study aimed to examine whether suicide attempts and patient states at baseline predicted subsequent suicide attempts, and whether suicide lethality increased in repeated attempts. METHODS:We assessed 119 adolescent inpatients at intake using self-report measures (Interpersonal Needs Questionnaire and Fearlessness About Death) and a behavioral measure (Implicit Association Test Death/Suicide). For adolescents with a recent suicide attempt, we used clinician-rated measures of suicide lethality and intent (Risk-Rescue Rating Scale and Suicide Intent Scale). Using logistic regression models, we examined whether these variables prospectively predicted suicide attempts during a six-month follow-up, and we compared the lethality of first-time and repeated attempts. RESULTS:Eighteen participants attempted suicide during follow-up. The combination of elevated unmet interpersonal needs and fearlessness about death predicted subsequent suicide attempts (OR = 2.81, p= .004) substantially better than either variable alone. Implicit association with death, suicidal intent, and lethality did not predict suicide attempts, and repeated attempts did not increase in lethality. CONCLUSIONS:The self-reported measures performed better than the behavioral and clinician-rated measures in prospective prediction of suicide attempts. The lack of predictive ability of suicide lethality, particularly the absence of escalation in repeated attempts, underscores the importance of adolescents' reports of distress over medical severity in understanding suicidal behavior.
OBJECTIVE:Identifying effective interventions for suicidal thoughts and behaviors (STBs) among Hispanic/Latine youth is a public health priority. Anxiety and depression often precede STBs, and non-suicide-specific treatments for internalizing problems may mitigate the development of serious suicidality. Transdiagnostic therapy for anxiety and depression has shown strong outcomes for Hispanic/Latine youth and some evidence of non-targeted effects on STBs. However, it remains unclear whether transdiagnostic treatments impact STBs in high-risk subgroups, such as depressed, Hispanic/Latine youth. The current study explored whether Hispanic/Latine ethnicity and depression moderated intervention-driven changes in suicidality within a transdiagnostic therapy for pediatric anxiety and depression. METHOD:Archival data were analyzed from the Brief Behavioral Therapy (BBT) trial for this hypothesis-generating study. Youths aged 8.0 to 16.9 were randomly assigned to receive BBT or assisted referrals to community care (ARC). Parent- and youth-reported suicidality was assessed at baseline and post-treatment (week 16). Multiple regression models were estimated in a subset of youth (n = 163) to test if ethnicity (Non-Hispanic White [NHW], Hispanic/Latine) and clinically significant depression moderated the impact of BBT on suicidality. RESULTS:Results indicated a significant three-way interaction between ethnicity, depression, and treatment, with significantly greater reduction in suicidality for depressed, Hispanic/Latine youth in BBT relative to community care by week 16. CONCLUSIONS:Findings demonstrate the promise of transdiagnostic interventions for reducing suicidality among depressed, Hispanic/Latine youth, a population that experiences elevated risk for STBs compared to NHW counterparts. Confirmatory trials are needed to test whether transdiagnostic treatment accrues specific benefits for suicidality for this vulnerable group.
OBJECTIVE:This study aimed to investigate the differences in perception of depressive symptoms, loneliness, and social support from friends between young adults with and without Non-Suicidal Self-Injury (NSSI) engagement in the past year. Moreover, we proposed a model analyzing the moderating effect of NSSI engagement in the mediating role of perceived social support from friends between depressive symptoms and loneliness. METHOD:A total of 320 young adults with a history of NSSI (aged 18-35 years) were assigned to two groups: NSSI engagement within the last 12 months (n = 160) and no NSSI episode in the previous 12 months (n = 160). Hayes' PROCESS macro for mediation analysis in SPSS was used to test the hypothesized model. RESULTS:Participants with NSSI engagement in the last 12 months manifested significantly higher levels of depressive symptoms and loneliness. Conversely, young adults without NSSI engagement in the last 12 months manifested higher levels of social support from friends. This study found that social support from friends mediated the relationship between depressive symptoms and loneliness. Moreover, the moderation model was significant, explaining that the indirect effect of social support from friends was significantly stronger among participants without NSSI engagement in the last 12 months. CONCLUSIONS:This study highlights the intricate interplay between depressive symptoms, loneliness, and social support from friends in a sample of Portuguese young adults with NSSI engagement behaviors in the last 12 months. These findings emphasize the need for a better understanding of factors that contribute to NSSI engagement behaviors particularly among young adults.
BACKGROUND:Sleep health is a key factor influencing mental and physical well-being. Existing research has predominantly focused on the relationship between single sleep problems and suicidal thoughts, lacking a comprehensive investigation from the perspectives of multidimensional sleep health and the life course. OBJECTIVE:This study aimed to utilize a large-scale sample to explore the association between multidimensional sleep health and suicidal thoughts, and to examine the moderating role of age in this relationship. METHODS:Using data from 35,502 Chinese adults, we assessed multiple sleep dimensions and suicidal thoughts via self-report. Analyses included linear regression, Canonical Correlation Analysis (CCA), and moderation tests. RESULTS:Regression analyses showed that, after controlling for covariates, poorer sleep health was significantly associated with a higher future suicide likelihood. Canonical Correlation Analysis further revealed a significant multivariate association between patterns of sleep health and patterns of suicidal behavior, primarily driven by insomnia and sleep variability. Moderation analysis indicated that age significantly moderated the relationship between sleep variability and suicidal thoughts; this association was strongest among young adults, followed by middle-aged adults, and weakest in older adults. Stratified Canonical Correlation Analysis also showed that the overall strength of the sleep-suicide association decreased with increasing age. CONCLUSION:Multidimensional sleep health, particularly insomnia and sleep variability, is a significant correlate of suicidal thoughts. The association is age-specific, highlighting the need for developmentally tailored, sleep-focused interventions.
BACKGROUND:Self-harm is a significant global public health challenge with substantial psychological and economic impacts. This study analyzes trends in self-harm, focusing on the effects of the COVID-19 pandemic and sociodemographic index (SDI) on self-harm outcomes. We aim to explore the association between temporal trends, SDI, and the global burden of self-harm. METHODS:Data from the Global Burden of Disease Study 2021 were used to evaluate age-standardized prevalence (ASPR), incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) rates across 204 countries. Percentage changes from 2019 to 2021 and estimated annual percentage change (EAPC) from 1990-2021 were calculated, and Spearman's correlation was used to analyze relationships between EAPC and SDI. Risk factors for self-harm mortality were also assessed. RESULTS:In 2021, 746,379 global deaths from self-harm were reported (ASMR = 8.99 per 100,000). Both ASPR and ASIR increased during the COVID-19 pandemic. Greenland had the highest burden, while South Asia showed significant sex differences, particularly higher prevalence and incidence among females. The burden of self-harm was elevated among individuals aged 70 and above. A positive correlation was found between ASMR and EAPC, and a negative one with SDI. High alcohol use accounted for 9.3% of self-harm deaths. CONCLUSIONS:The study highlights the need for targeted mental health interventions, particularly in regions like Greenland, South Asia, and among older adults. The pandemic's impact on self-harm rates underscores the urgency of mental health support, especially in lower SDI regions, to mitigate risk factors such as high alcohol use.
OBJECTIVE:This study examined whether death-related thoughts, passive suicidal ideation (SI), and active SI prospectively predict risk of alcohol use disorder (AUD) and cigarette use among sexual minority women (SMW), and whether these associations differ by exposure to single versus multiple forms of sexual violence. METHOD:Data came from a 24-year, five-wave U.S. longitudinal study of SMW's health, using Waves 3 (2010-2012; N = 726) and 4 (2017-2019; N = 525). Multivariable logistic regression models tested associations between Wave 3 sexual violence exposure (single type, multiple types, vs. none) and death-related thoughts, passive SI, and active SI. Additional models examined whether Wave 3 death-related thoughts and SI predicted Wave 4 AUD risk and cigarette use, adjusting for sociodemographic characteristics and Wave 3 alcohol and cigarette use. Moderation by sexual violence exposure was tested using interaction terms. RESULTS:Exposure to a single type of sexual violence was associated with death-related thoughts, whereas exposure to multiple types was associated with both death-related thoughts and active SI. Prospectively, death-related thoughts predicted AUD risk, and passive SI predicted cigarette use. Exploratory analyses suggested that the association between death-related thoughts and cigarette use was stronger among SMW without sexual violence histories than among those with exposure to multiple types of sexual violence. CONCLUSIONS:These findings highlight sexual violence as a determinant of death- and suicide-related cognitions and demonstrate that these cognitions prospectively shape substance use risk among SMW. Results underscore the importance of targeting upstream cognitive vulnerability processes in trauma-responsive prevention and intervention efforts.
OBJECTIVE:While the association between suicide and sleep problems has been reported, the effect size and temporal directionality remain unclear. This study examined whether sleep problems prospectively predict suicidal ideation. METHODS:In 2022, a self-administered online questionnaire including the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-9, and the Suicidal Ideation Scale (SIS) was distributed to a stratified random sample from a web survey panel and to local city government officers. The same questionnaire was administered again after 3 months. Cross-lagged model analyses were conducted to assess temporal and directional associations. RESULTS:A total of 652 participants (mean age, 49.7 years) provided valid responses at both time points. Weak suicidal ideation was observed in 25.2% of participants, and moderate-to-strong ideation in 3.7% (SIS Q1: "wish to die"). Sleep disturbance (PSQI ≥ 6) was observed in 32.8% of participants. Cross-lagged analyses showed that PSQI global score and sleep latency prospectively predicted suicidal ideation. These associations remained significant after adjusting for depressive symptoms. Bidirectional associations between sleep disturbance and suicidal ideation were also observed. The presence of sleep disturbance predicted future suicidal ideation in univariate analysis (OR = 3.97) and remained significant in the PHQ-9-adjusted model (OR = 1.59). CONCLUSION:Sleep problems were identified as prospective predictors of suicidal ideation. Sleep disturbances may represent modifiable targets for intervention in suicide prevention.
Adolescent suicidality is a pressing global health concern, yet group-based therapeutic interventions for this population remain underexplored. This scoping review aimed to systematically map the existing literature on group therapy for adolescents and young adults aged 10-25 years experiencing suicidal ideation or behaviors. Ten peer-reviewed studies were identified through a comprehensive database search and analyzed across key dimensions, including participant demographics, interventions' theoretical frameworks, therapeutic mechanisms, intervention structure, clinical outcomes, and implementation challenges. The findings reveal that group therapy for adolescents at risk of suicide is applied using a variety of theoretical orientations, including cognitive-behavioral, dialectical-behavioral, psychodynamic, and narrative approaches, and across diverse clinical settings. Most interventions were short and time limited. Interventions generally yielded positive outcomes, including reductions in suicidal ideation, depressive symptoms, anxiety, and emotional dysregulation. Despite promising results, studies also had methodoligocal limitations, including small samples and most studies lacked control group or randomization. Furthermore, few interventions included cultural adaptation or addressed the potential risk of suicide contagion in group settings. Taken together, findings underscore the need for further research employing rigorous designs and culturally informed practices. Nonetheless, group therapy appears to be a potentially effective component in the continuum of care for adolescents at risk of suicide.
OBJECTIVE:Suicide remains a growing concern in the United States, with a 35% increase since 2000. Leading experts emphasize the urgent need for effective, suicide-specific treatments. This retrospective study followed a quality improvement design, using a convenience sample and providing transparency of the treatment being provided. Pre- and post- test scores on the Suicide Status Form (SSF-4) were utilized to evaluate suicidal resolution outcomes of The Hope Institute (THI), a novel approach to outpatient treatment for suicidal ideation. THI was built upon evidence-based models, developing a structured approach to suicide treatment that can be implemented and replicated in an outpatient setting. METHOD:The study sample consisted of 58 participants with a mean age of 20 years. Notably, 31% of participants had no prior mental health diagnosis, reinforcing the need for interventions that address suicide risk beyond traditional psychiatric models. RESULTS:Results demonstrated significant reductions in SSF-4 Core Assessment during treatment, with a large effect size (t(57) = 8.1, p < .001, d = 1.02). Participants achieved resolution in an average of 5.6 weeks, with 98% successfully completing treatment and 5% experiencing readmission to THI or another facility within 90 days. The timeline reflects the adaptability of THI, with trained clinicians collaborating with patients to determine treatment frequency and focus on a patient-centered, evidence-based, approach to foster patient autonomy and suicidal resolution. CONCLUSION:Individuals in the sample demonstrated statistically significant pre/post improvements in reductions in suicide risk scores, warranting additional research on THI program effectiveness in larger community samples.
OBJECTIVES:This study aims to synthesize qualitative evidence on the lived experiences and perceived support needs of suicide-bereaved family members, including extended relatives. METHODS:A qualitative systematic review and quote-based thematic meta-synthesis was conducted. Searches were undertaken in PubMed, Scopus, and Web of Science. Eligible studies were primary qualitative research published in English involving family members bereaved by suicide. Methodological quality was appraised using the JBI Critical Appraisal Checklist for Qualitative Research, and confidence in each synthesized finding was assessed using GRADE-CERQual. Verbatim participant quotations extracted from findings/results sections were analyzed using Braun and Clarke's thematic analysis, guided by Doka's disenfranchised grief as a sensitizing framework, with inductive coding for data not captured by the lens. RESULTS:Twenty-seven studies were included. Six cross-cutting themes described suicide bereavement as layered disenfranchisement: (1) stigma and anticipatory judgment prompting secrecy and withdrawal; (2) relational erasure through silence and loss of permission to name the deceased; (3) institutional non-recognition and lack of navigable postvention pathways; (4) moral injury and persistent culpability; (5) embodied, trauma-like distress and enduring existential suffering; and (6) legitimacy repair through peer support, compassionate witnessing, continuing bonds, and meaning-making. Synthesized support needs converged on stigma-competent and culturally safe care, permission-based communication, proactive coordinated pathways, trauma-informed long-term follow-up with attention to suicide risk, and accessible, tailored peer support. CONCLUSION:Suicide bereavement among family members is frequently shaped by social, relational, and institutional disenfranchisement, with important implications for designing proactive, culturally safe, and longitudinal postvention that addresses both symptom burden and social-ecological barriers.
OBJECTIVE:Death by suicide among U.S. servicemembers is a significant public health concern - firearms are the primary method of suicide for active-duty servicemembers. The Overwatch Project provides peer-based firearms lethal means safety training for servicemembers to mitigate future risk. This study reports on the effectiveness of this training. METHODS:This longitudinal, quasi-experimental and matched-cohort study evaluated the effectiveness of the Overwatch Project by comparing pre-, post-, and two-month follow-up self-report data for active-duty servicemembers who attended the training (Arm1/Overwatch Project, n = 451) and those who did not (Arm2/Comparison Group, n = 451). RESULTS:Participation in the Overwatch Project training was associated with a significant increase in servicemembers meeting the minimum score on a firearms lethal means safety knowledge assessment (within group; pre-training: 8% vs. post-training: 85%), readiness in executing proactive firearms lethal means safety tasks (between group), creation of a proactive firearms lethal means safety plan for themselves (within group; pre-training: 26% vs. two-month follow-up: 68%), and creation of a similar plan with a peer (within group; pre-training: 26% vs. two-month follow-up: 37%). CONCLUSION:Preliminary findings suggest that the Overwatch Project peer-based firearms lethal means safety training is a promising step towards reducing firearm suicides among servicemembers.
