Research suggests that frequent empathic engagement with others in distress places helpers in registered professional roles (e.g. medical practitioners, psychologists) at risk of functional impairment related to symptoms of psychological distress, including the delivery of sub-optimal care to patients. Preliminary research suggests that telephone crisis support workers may also be impacted in a similar way. This repeated measures study is the first known research to examine telephone crisis support workers' functional impairment related to symptoms of psychological distress before and after speaking with callers in crisis. A representative sample of telephone crisis support workers from Lifeline Australia participated by completing three surveys: 1) directly before; 2) directly after; and 3) one week after completing a shift on the national crisis line. Surveys included standardised measures of functional impairment, psychological distress, lived experience of mental health issues and suicide, motivations for volunteering, coping strategies and help-seeking. Categorical items were used to assess personal and shift related factors. Repeated measures analyses of variance were used to identify changes in symptoms of psychological distress and impairment across time points. Structural equation modelling was used to test relationships within a hypothesised model of impairment. A significant proportion of participants reported functional impairment related to symptoms of psychological distress. Significant differences in functional impairment and symptoms of psychological distress were detected, and were associated with different mechanisms, across time points. An important outcome of this study is empirically-supported models which explain how telephone crisis support workers come to experience functional impairment in relation to their TCS role, as well as other work/study, home/family and social/leisure activities. Results warrant the deliberate development and/or modification of existing service strategies to optimise telephone crisis support workers' psychological wellbeing and functioning, including by structuring the work environment and emphasising certain messages during training and supervision.

BACKGROUND:Young people experiencing mental health problems are often reluctant to seek help, particularly from professionals (i.e., doctors or mental health workers). MAKINGtheLINK is a school-based intervention that aims to help adolescents overcome barriers to seeking professional help for mental health and substance use problems. METHODS:A cluster randomised controlled trial was conducted to evaluate the 12-month outcomes of MAKINGtheLINK among 2447 participants (Mean age=14.9 years, SD=0.5 years, 50% male). Randomisation resulted in 1130 students from 11 schools allocated to receive the intervention, and 1317 students from 10 schools allocated to the wait-list control group. After the baseline assessment, follow-ups were conducted at 6-weeks (n = 2045), 6-months (n = 1874), and 12-months (n = 1827). The primary outcome measure was help-seeking behaviour, from both formal (e.g., health professionals) and informal (e.g., friends, family members) sources. The trial was registered with the Australia and New Zealand Clinical Trials Register (ANZCTR) on the 27th of February 2013 (registration number ACTRN12613000235707). FINDINGS:The intervention was not associated with overall help-seeking at the 12-month follow-up (p = 0.99, odds ratio [OR]=1.00, 95% CI for OR = 0.70-1.42), or help-seeking for depression (p = 0.28, OR = 1.21, 95%CI =0.86-1.69), stress and anxiety (p = 0.73, OR = 1.04, 95%CI = 0.74-1.47), or alcohol/other drugs (p = 0.84, OR=1.12, CI=0.37-3.37). However, the intervention was associated with increased help-seeking from formal sources (compared to informal sources) both overall (p = 0.005, OR = 1.81, 95%CI = 1.19-2.75), as well as for depression (p = 0.01, OR=2.09, 95%CI=1.19-3.67), and stress and anxiety (p < 0.006, OR = 1.72, 95%CI = 1.17-2.54). INTERPRETATION:Rates of help-seeking remained unchanged following the intervention. However, MAKINGtheLINK effectively improved the quality of adolescent help-seeking behaviour by increasing help-seeking from formal sources. As prompt treatment is essential in reducing the long-term impact of early onset mental health problems, MAKINGtheLINK has the potential to make a significant contribution to existing early intervention and prevention efforts. FUNDING:National Health and Medical Research Council (APP1047492).

Hanging is a common method of suicide in several countries. Even as global suicide rates decrease, there is no evidence of suicides by hanging declining. There is limited research by type of hanging, and only a few papers present suicide by hanging from ceiling fans. Our paper proposes a research agenda that will: specify the size of the problem of hanging by ceiling fan (Stage 1: Surveillance), use standard engineering product development processes to modify ceiling fans for reducing their lethal capacity (Stage 2: Design Testing and Redevelopment), and examine the resulting beta- and release-build fans for safety and potential to reduce suicide in community samples (Stage 3: Evaluation).

Background and Objective: Adolescents experiencing mental health problems often approach their peers rather than seeking professional help. A better understanding of adolescents’ stigmatising attitudes towards mental illness will help inform interventions that aim to improve the quality of advice that young people provide to their peers. In particular, there is a need for research examining adolescents’ attitudes towards alcohol misuse, given it’s increase in prevalence during this period as well as the adverse outcomes that are associated with untreated early drinking problems. Methods: High-school students (n=2447) were recruited as part of an intervention focussed on overcoming barriers to accessing help for mental health and substance use problems. Participants were presented with two vignettes that described a peer experiencing depression and alcohol misuse, respectively, and completed the General Help-Seeking Questionnaire as well as a 10-item scale measuring stigmatising attitudes. Past helping behavior was also assessed. Results: Compared to depression, a peer experiencing alcohol misuse was more likely to be considered “weak” rather than sick, and was perceived as more dangerous and unpredictable. The “weak-not-sick” and “dangerousness” dimensions of stigma predicted weaker intentions to encourage help-seeking from informal sources, while ‘dangerousness’ predicted stronger intentions to encourage formal help-seeking. Both dimensions were associated with fewer instances of past helping behavior. Conclusion: Young people stigmatise alcohol misuse more severely than depression. Overall, stigma was associated with weaker intentions to encourage peers to seek help. While perceptions of ‘dangerousness’ were associated with stronger intentions to seek help from formal sources, this association may not translate into actual helping behavior.

Signs of suicide are commonly used in suicide intervention training to assist the identification of those at imminent risk for suicide. Signs of suicide may be particularly important to telephone crisis-line workers (TCWs), who have little background information to identify the presence of suicidality if the caller is unable or unwilling to express suicidal intent. Although signs of suicide are argued to be only meaningful as a pattern, there is a paucity of research that has examined whether TCWs use patterns of signs to decide whether a caller might be suicidal, and whether these are influenced by caller characteristics such as gender. The current study explored both possibilities. Data were collected using an online self-report survey in a Australian sample of 137 TCWs. Exploratory factor analysis uncovered three patterns of suicide signs that TCWs may use to identify if a caller might be at risk for suicide (mood, hopelessness, and anger), which were qualitatively different for male and female callers. These findings suggest that TCWs may recognise specific patterns of signs to identify suicide risk, which appear to be influenced to some extent by the callers' inferred gender. Implications for the training of telephone crisis workers and others including mental-health and medical professionals, as well as and future research in suicide prevention are discussed.

This paper aimed to identify men men and women's prevalence and predictors of psychological outcomes, as well as their coping strategies, in communities affected by the October 2013 bushfires in the Blue Mountains region of Australia. 189 participants took part in a paper-and-pencil or online survey that included closed and open-ended questions about their fire- and community-related experiences, psychological outcomes and coping strategies. Almost half of participants reported probable PTSD (45%), while 23% reported psychological distress and 16% reported heavy drinking, with men drinking significantly more than women (OR: 0.41, 95% CI: 0.18-0.91, p = .03). Psychological distress was predicted by higher level of risk during fires, property damage and lower perceived community cohesion, whereas PTSD was predicted by property damage and female gender. Participants named various coping strategies including seeking social and community support, sharing information and resources, and seeking help from professional and volunteer organisations. A few participants also observed gender differences in coping, i.e. some men were perceived to engage more in problem-solving coping, whereas women in accessing emotional-focused strategies. Findings indicate the need to further assess community resilience and how to draw on men and women's strengths in order to rebuild and promote mental health and wellbeing post-fires.

Telephone crisis-line workers (TCWs) are trained in a variety of techniques and skills to facilitate the identification of suicidal callers. One factor that may influence the implementation of these skills is gender. This study used an experimental design to explore whether helpline callers being identified as male or female is associated with TCWs’ ratings of callers’ potential for suicide risk and TCWs’ intention to use support- or intervention-oriented skills with callers. Data were collected using an online self-report survey in an Australian sample of 133 TCWs. The results suggest that under some circumstances the callers’ gender might influence TCWs’ intention to use intervention-oriented skills with the caller. Implications for the training of telephone crisis workers, and those trained in suicide prevention more broadly are discussed.

Telephone crisis support is a confidential, accessible, and immediate service that is uniquely set up to reduce male suicide deaths through crisis intervention. However, research focusing on telephone crisis support with suicidal men is currently limited. To highlight the need to address service delivery for men experiencing suicidal crisis, this perspective article identifies key challenges facing current telephone crisis support research and proposes that understanding of the role of telephone crisis helplines in supporting suicidal men may be strengthened by careful examination of the context of telephone crisis support, together with the impact this has on help-provision for male suicidal callers. In particular, the impact of the time-and information poor context of telephone crisis support on crisis-line staff's identification of, and response to, male callers with thoughts of suicide is examined. Future directions for research in the provision of telephone crisis support for suicidal men are discussed.

Background: In order to respond to crises with appropriate intervention, crisis workers are required to manage their own needs as well as the needs of those they respond to. Aims: A systematic review of the literature was conducted to examine whether telephone crisis support workers experience elevated symptoms of psychological distress and are impaired by elevated symptoms. Method: Studies were identified in April 2015 by searching three databases, conducting a gray literature search, and forward and backward citation chaining. Results: Of 113 identified studies, seven were included in the review. Results suggest that that telephone crisis support workers experience symptoms of vicarious traumatization, stress, burnout, and psychiatric disorders, and that they may not respond optimally to callers when experiencing elevated symptoms of distress. However, definitive conclusions cannot be drawn due to the paucity and methodological limitations of available data. Limitations: While the most comprehensive search strategy possible was adopted, resource constraints meant that conference abstracts were not searched and authors were not contacted for additional unpublished information. Conclusion: There is an urgent need to identify the impact of telephone crisis support workers' role on their well-being, the determinants of worker well-being in the telephone crisis support context, and the extent to which well-being impacts their performance and caller outcomes. This will help inform strategies to optimize telephone crisis support workers' well-being and their delivery of support to callers.

Objectives: To determine if adolescents perceive community-based exercise as beneficial to their well-being and in what ways. Methods: A New South Wales Police Citizens Youth Club ran a four-week fitness course. The classes involved: 1) sports including basketball and soccer, 2) non-contact boxing drills, and 3) games, both team games such as dodgeball and non-team games such as line tag. Parental consent to offer a survey at the completion of the course was requested during registration. The survey was the Warwick Edinburgh Mental Well-being Scale; it was minimally modified to measure perceived benefit to mental well-being instead of actual benefit. Results: Thirty-one high school adolescents, ages 13–18, completed the survey. As a group, participants reported that they believed their well-being had improved after the course. The mean score for each survey item showed an improvement in every area of mental well-being for this sample of adolescents. Thirty-two per cent of adolescents reported having less energy. Survey scores indicated a statistically significant improvement in perceived well-being ( p<0.0001). Conclusions: The results of this study suggest that four weeks of community-based exercise improves perceived mental well-being in adolescent participants.

Australian & New Zealand Journal of Psychiatry, 51(12) prominent example, which supports this observation, is the internationally reported case of the so-called ‘Facebook Murderer’, who in April 2017 published a live-video of his crime on a social network. Social networks, which are being used more heavily by people with narcissistic personality characteristics, may encourage at-risk persons to commit crimes in order to reach a wider audience. In this regard, it seems necessary to educate Internet users primarily by highly specialized teaching programs, in schools and other educational institutions that their (online) reactions to videos and pictures of crimes may inspire or motivate future perpetrators. A main aspect of such specialized teaching programs should be online and social media–based exercises.

Background: It is well known that helping professionals experience functional impairment related to elevated symptoms of psychological distress as a result of frequent empathic engagement with distressed others. Whether telephone crisis support workers are impacted in a similar way is not currently reported in the literature. Aims: The purpose of this study was to test a hypothesized model of factors contributing to functional impairment in telephone crisis support workers. Method: A national sample of 210 telephone crisis support workers completed an online survey including measures of emotion regulation, symptoms of general psychological distress and suicidal ideation, intentions to seek help for symptoms, and functional impairment. Structural equation modeling was used to test the fit of the data to the hypothesized model. Results: Goodness-of-fit indices were adequate and supported the interactive effects of emotion regulation, general psychological distress, suicidal ideation, and intentions to seek help for ideation on functional impairment. Conclusion: These results warrant the deliberate management of telephone crisis support workers' impairment through service selection, training, supervision, and professional development strategies. Future research replicating and extending this model will further inform the modification and/or development of strategies to optimize telephone crisis support workers' well-being and delivery of support to callers.

OBJECTIVE:While some studies suggest that men and women report different symptoms associated with depression, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of gender differences in symptoms associated with depression. METHODS:PubMed, Cochrane, and PsycINFO databases, along with further identified references lists, were searched. Thirty-two studies met the inclusion criteria. They included 108,260 participants from clinical and community samples with a primary presentation of unipolar depression. All 32 studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the 26 symptoms identified across the 32 studies to assess for the effect of gender. RESULTS:The studies indicate a small, significant association of gender with some symptoms. Depressed men reported alcohol/drug misuse (Hedges's g = 0.26 [95% confidence interval (CI), 0.11-0.42]) and risk taking/poor impulse control (g = 0.58 [95% CI, 0.47-0.69]) at a greater frequency and intensity than depressed women. Depressed women reported symptoms at a higher frequency and intensity that are included as diagnostic criteria for depression such as depressed mood (g = -0.20 [95% CI, -0.33 to -0.08]), appetite disturbance/weight change (g = -0.20 [95% CI, -0.28 to -0.11]), and sleep disturbance (g = -0.11 [95% CI, -0.19 to -0.03]). CONCLUSIONS:Results are consistent with existing research on gender differences in the prevalence of substance use and mood disorders, and of their co-occurrence. They highlight the potential utility of screening for substance misuse, risk taking, and poor impulse control when assessing depression in men. Future research is warranted to clarify gender-specific presentations of depression and co-occurring symptoms.

Background: Many young people are reluctant to seek professional help for mental health problems, preferring to rely on their friends for support. It is therefore important to ensure that adolescents can identify signs of psychological distress in their peers, talk to them about these, and help them access appropriate services when necessary. The current study examined adolescents' ability to recognise symptoms of depression and alcohol misuse, perceived barriers to help-seeking, and their intentions to encourage a peer to seek help from a range of informal and formal help sources.Method: The current study used baseline data from a randomised controlled trial of a school-based intervention that teaches adolescents how to overcome barriers to accessing professional help for mental health and substance use problems (MAKINGtheLINK). Participants (n = 2456) were presented with two vignettes portraying depression and alcohol misuse, respectively, and were asked to identify the problems described. Participants provided data on their past help-seeking behaviour, confidence to help a peer, perceived barriers to help-seeking, and intentions to encourage a peer to seek help.Results: Health professionals were the main source of help that participants had relied on for depressive symptoms, followed by friends and parents. In contrast, friends were the main source of help that participants had relied on for alcohol and other drug problems, followed by health professionals and parents. Just over half of the sample correctly identified the problems described in the two vignettes, although the majority of participants were confident that they could talk to a peer and help them seek professional help if needed. Most agreed that the vignettes described problems that warranted professional help, however approximately half the sample was unsure or considered it unlikely that they would seek help if they experienced similar problems. For both disorders, participants were most likely to encourage a peer to seek help from their family, followed by formal help sources and friends.Conclusions: While the results point towards a greater willingness to approach formal help sources, particularly for depression, peers remain an important source of support for young people experiencing mental health and substance use problems.

"Could explicit teaching of coping planning in suicide prevention curricula improve resilience in medical students?." Medical Teacher, 39(7), p. 680

Suicide signs have been identified by expert consensus and are relied on by service providers, community helpers' and family members to identify suicidal men. Whether signs that are reported in suicide literature accurately describe male presentations of suicidality is unclear. A systematic review of the literature was conducted to identify male-specific signs of current suicidality and identify gaps in the literature for future research. Searches through Medline, CINAHL, PsychInfo and the Behavioral Sciences Collection, guided by the PRISMA-P statement, identified 12 studies that met the study eligibility criteria. Although the results generally reflected suicide signs identified by expert consensus, there is little research that has examined male-specific signs of the current suicidal state. This review highlights the need for scientific research to clarify male presentation of suicidality. Implications for future research to improve the prompt identification of suicidal men are discussed.